HCPCS Modifier Q9

• Routine foot care is not a covered Medicare benefit. Medicare assumes that the beneficiary or caregiver will perform these services by themselves, and they are therefore excluded from coverage. Medicare allows exceptions to this exclusion when medical conditions exist that place the patient at increased risk of infection and/or injury if a non-professional were to provide these services. Medicare may cover routine foot care in the following situations:
  • The routine foot care is a necessary and integral part of otherwise covered services
    • In certain circumstances, services ordinarily considered to be routine may be covered if they are performed as a necessary and integral part of otherwise-covered services, such as the diagnosis and treatment of ulcers, wounds or infections
  • The patient has a systemic condition
    • The presence of a systemic condition such as metabolic, neurologic or peripheral vascular disease may result in severe circulatory embarrassment or areas of diminished sensation in the individual's legs or feet. In these instances, certain foot care procedures that otherwise are considered routine (as defined previously) may pose a hazard when performed by a nonprofessional person.
    • For a list of systemic conditions that might justify coverage, refer to CMS Pub. 100-02, chapter 15, section 290.D (PDF, 1.29 MB)
• Submit this modifier with routine foot care (CPT codes 11055–11057, 11719, 11720 or 11721, or HCPCS code G0127) to indicate that the patient has one Class B and two Class C findings that qualify the service for coverage under Medicare

• Absent posterior tibial pulse
• Absent dorsalis pedis pulse
• Advanced trophic changes (at least three of the following):
  • Decrease or absence of hair growth
  • Nail thickening
  • Skin discoloration
  • Thin and shiny skin texture
  • Rubor or redness of skin

Class C Findings

• Claudication
• Temperature changes (cold feet)
• Edema
• Paresthesia (abnormal spontaneous sensations in feet)
• Burning

• The cutting or removal of corns or calluses
• The trimming, cutting, clipping or debriding of nails
• Hygienic and preventive maintenance care such as:
  • Cleaning and soaking the feet
  • The use of skin creams to maintain skin tone of either ambulatory or bedfast patients
  • Any other service performed in the absence of localized illness, injury or symptoms involving the foot

Reference: CMS Pub. 100-02, Chapter 15, Section 290 (PDF, 1.29 MB).