Covered/Not-Covered Nail Care

by | Mar 13, 2018

Will My Nail Care Be Covered By My Insurance?

Many patients come to us for routine foot care. During these appointments nails are trimmed or debrided and calluses cared for. Unfortunately, many patients, especially the elderly or those with mobility issues have trouble performing this care themselves. We are always happy to help out those who need. However, insurance doesn’t always cover this care.

Below are some scenarios under which nail care would or would not be covered.

I’m a diabetic, is my nail care covered?

If you have diabetes with no other complications such as neuropathy or PVD (peripheral vascular disease) routine foot care is NOT covered.

  • Generally we try and see our diabetic patients 1-2 times per year for a diabetic foot check.
  • At your appointment the doctor will assess for any sensation loss (neuropathy) or poor blood flow (PVD).
  • They will then discuss these topics with you and ways to prevent issues.
  • If you meet the criteria for neuropathy or PVD your nail care may be covered.

 I have poor blood flow, is my nail care covered?

  •  This depends on a couple of factors that will be assessed during your appointment.
  •  The doctor will check your pulses and peripheral blood flow along with your skin and even your lower legs for signs of PVD
  •  If adequate signs are met your nail care may be covered.

My nails are thick and hard to trim, is my nail care covered?

  • Generally speaking nails that are painful, cause an inability to walk and are greater than 3mm in thickness are covered for routine foot care.

My nails are normal but I can’t trim them myself, is my nail care covered?

  • Generally speaking no. Unless you meet one of the above criteria your nail care would not be covered.

We have made the following chart to help you determine if your nail care will be covered –

PFA diabetic nail coverage flow chart

Please do not hesitate to call our office for more information. Please note that we cannot determine or guarentee coverage over the phone. An evaluation by the doctor is always necessary to determine coverage. Please use the scenarios and chart above as a reference – they are not a guarantee of coverage. Every insurance company is different and we cannot guarantee coverage without a medical evaluation. 

Natasha Baczewski, DPM is a podiatric surgeon at Northeast Foot and Ankle. She currently accepts new patients. To read more about Dr. B or to make an appointment with her please use the following links: Dr. Natasha Baczewski  |  Appointment Request

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