The Centers for Medicare and Medicaid Services (CMS) recently announced that, effective July 1, 2002, Medicare will cover, as a physician service, an evaluation (examination and treatment) of the feet no more often than every six months for individuals with a documented diagnosis of diabetic sensory neuropathy and loss of protective sensation (LOPS), as long as the patient has not seen a foot care specialist in the interim.

The applicable new HCPCS Codes required for reporting these services are as follows:

HCPCS       Code Descriptor
GO245        Initial physician evaluation of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation

[This initial examination must include a diagnosis of LOPS, patient history, physical examination that includes an inspection of the forefoot, hindfoot, and toe web spaces; evaluation of: protective sensation, foot structure and biomechanics, vascular status and skin integrity, evaluation and recommendation of footwear, and providing of patient education.]

It is important to note that each provider or provider group of which a physician is a member, may only receive reimbursement once for G0245 for each beneficiary. However, should that beneficiary need to see a new provider, that new provider may also be reimbursed once for G0245 for that beneficiary.

GO246       Follow-up evaluation of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS)

[This follow-up examination must include a diagnosis of LOPS, patient history, physical examination that includes an inspection of the forefoot, hindfoot, and toe web spaces; evaluation of: protective sensation, foot structure and biomechanics, vascular status and skin integrity, evaluation and recommendation of footwear, and providing of patient education.]

GO247      Routine foot care of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS)

[If present, this care must include local care of superficial wounds, debridement of corns and calluses, and trimming and debridement of nails.]

Code GO247      Must be billed on the same date of service with either GO245 or GO246 in order to be considered for payment.

CPT/HCPCS Code

Non-Facility Physician

In-Facility Physician Fee

G0245

$62.54

$45.98

G0246

$36.42

$23.17

G0247

$39.36

$27.96

CPT/HCPCS Code

Non-Facility Total RVU

In-Facility Total RVU

G0245

1.7

1.25

G0246

0.99

0.63

G0247

1.07

0.76

250.60

Diabetes with Neurological Manifestations, Type II, [Non-Insulin Dependent Type] [Adult-Onset Type] or Unspecified Type, Not Stated as Uncontrolled

Fifth-digit "0" is for use for type II, adult-onset diabetic patients, even if the patient requires insulin.

Fifth-digit "2" is for use for type II, adult-onset diabetic patients, even if the patient requires insulin.