Medicare Coverage for Toenail Clipping

by: Patricia Barry | from: AARP Bulletin | September 22, 2008

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Q. I go to a podiatrist to have my toenails clipped. As I’m diabetic, shouldn’t Medicare cover the cost?

A. Maybe, but it depends on the circumstances. Medicare doesn’t normally cover nail clipping or any kind of routine foot care. You’re correct that diabetes mellitus is one of the medical conditions that may justify coverage—but only if:

* A doctor has been treating you for diabetes in the six months before the nail clipping;

AND

* You have a complication of diabetes that is either limiting your ability to walk or is affecting your feet adversely—for example, loss of sensation, muscle pain, swellings, ulcers, mycosis (fungal infection) of the toenails, etc.; or

* You have a condition related to your diabetes affecting your feet that would make it unsafe for anyone except a podiatrist or other health professional to clip your nails.

These coverage rules also apply to foot problems that result from other medical conditions besides diabetes, including cancer, multiple sclerosis, chronic kidney disease, malnutrition and inflammation of the veins related to blood clots.

The bottom line: To get Medicare coverage for foot care, you need your doctor or podiatrist to provide evidence as to why it is medically necessary.

Patricia Barry is a senior editor at the AARP Bulletin.