Does Medicare Cover Toenail Removal?

Medicare, the federal health insurance program, provides coverage for millions of Americans aged 65 or older, and certain younger individuals with disabilities or specific medical conditions. It is designed to help with healthcare costs. While Medicare generally covers medically necessary services, coverage for foot care can be complex and depends on individual circumstances.

General Medicare Coverage for Foot Care

Medicare Part B, the medical insurance component of Original Medicare, covers outpatient services, including those provided by podiatrists. Medicare distinguishes between “routine foot care” and “medically necessary foot care.” Routine foot care, such as nail trimming or callus removal, is typically not covered. Beneficiaries are usually responsible for 100% of these costs.

Medicare Part B may cover foot care services if they are medically necessary to diagnose or treat an illness, injury, or condition. Services must be performed by a Medicare-approved healthcare professional to qualify for coverage.

Specific Medical Conditions for Coverage

Medicare Part B covers toenail removal when medically necessary due to specific underlying conditions. This includes situations where the toenail issue poses a direct risk to a beneficiary’s health or is part of a broader treatment plan. For example, removal is covered if an ingrown toenail causes significant pain, swelling, or infection. If a toenail is infected and requires professional removal to prevent further complications, Medicare typically covers the procedure.

Trauma to the toenail resulting in severe pain or an elevated risk of infection can also warrant coverage. Toenail removal may be covered if necessary due to a systemic condition that makes routine care risky for the beneficiary. This applies to individuals with conditions such as diabetes with peripheral neuropathy or severe peripheral vascular disease, which can impair circulation and sensation in the feet. For these individuals, minor foot problems can quickly escalate to serious infections or ulcers, requiring professional intervention. The patient must generally be under the active care of a physician for the systemic condition, often requiring a recent visit.

Understanding Your Out-of-Pocket Costs

If toenail removal is medically necessary and covered by Medicare, beneficiaries will incur out-of-pocket costs under Original Medicare (Parts A and B). For Part B services, beneficiaries must first meet an annual deductible. In 2025, the Medicare Part B deductible is $257. After this deductible is satisfied, Medicare typically pays 80% of the Medicare-approved amount, leaving the beneficiary responsible for the remaining 20% coinsurance. There is no annual limit on this 20% coinsurance under Original Medicare.

Medicare Advantage (Part C) plans, offered by private insurance companies, must cover at least the same services as Original Medicare. These plans can structure costs differently, often using copayments instead of coinsurance. Out-of-pocket costs in Medicare Advantage plans can vary, and some plans may offer additional benefits not covered by Original Medicare. Many beneficiaries also purchase a Medicare Supplement Insurance (Medigap) policy to help cover deductibles, coinsurance, and copayments associated with Original Medicare. Medigap policies sold to new Medicare enrollees since January 1, 2020, do not cover the Medicare Part B deductible.

Steps to Secure Coverage

Beneficiaries should seek care from a Medicare-enrolled podiatrist or physician. Before the service, discuss the procedure with your healthcare provider and ensure medical necessity for toenail removal is clearly documented. This documentation is crucial for billing and must justify why the service is a medically required intervention, not routine foot care.

For some Medicare Advantage plans, a referral from a primary care physician might be necessary before seeing a specialist. Beneficiaries should verify their plan’s requirements to avoid unexpected costs. If a claim for toenail removal is denied, beneficiaries have the right to appeal the decision. The appeals process involves several levels, including reconsideration and administrative hearings. Beneficiaries typically have 120 days from receiving a denial notice to initiate an appeal, and providing supporting documentation can strengthen their case.