{"id":181341,"date":"2026-08-17T11:11:41","date_gmt":"2026-08-17T11:11:41","guid":{"rendered":"https:\/\/pabau.com\/?p=181341"},"modified":"2026-08-17T12:33:14","modified_gmt":"2026-08-17T12:33:14","slug":"hcpcs-code-g0247","status":"publish","type":"post","link":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-g0247\/","title":{"rendered":"HCPCS code G0247: How to bill routine foot care for LOPS"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"HCPCS code G0247: How to bill routine foot care for LOPS\",\"description\":\"G0247 covers routine foot care for diabetic patients with LOPS, but it never pays alone. Find out which same-date code it needs, and how to stop denials.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-g0247\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-07\",\"dateModified\":\"2026-08-17\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>HCPCS code G0247 covers routine foot care for a diabetic patient with confirmed loss of protective sensation (LOPS).<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The descriptor lists wound care, corn and callus debridement, and nail work, but only the components present at that visit.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>G0247 never pays on its own. Medicare accepts it only when G0245 or G0246 is on the same claim and date.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>G0247 has no frequency limit of its own. The evaluation codes it rides on are payable once every six months per patient.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>A routine foot care CPT code paid in the prior six months blocks all three LOPS codes, so read payment history first.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">HCPCS code G0247 covers routine foot care for a diabetic patient with loss of protective sensation, known as LOPS. Medicare accepts G0247 only when the evaluation code it belongs with, G0245 or G0246, sits on the same claim and date of service.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Everything below follows the CMS Medicare Claims Processing Manual, Publication 100-04, Chapter 32, Section 80. Check any workflow change with your biller or compliance officer before you roll it out.<\/p>\n\n\n\n<h2 id=\"h-what-hcpcs-code-g0247-covers-word-for-word\" class=\"wp-block-heading\">What HCPCS code G0247 covers, word for word<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">G0247 describes routine foot care by a physician for a diabetic patient whose sensory neuropathy has caused LOPS. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CMS maintains the descriptor in the Healthcare Common Procedure Coding System, or <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\" target=\"_blank\" rel=\"nofollow noopener\">HCPCS<\/a>. It reads &#8222;to include if present, at least the following&#8220;:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Local care of superficial wounds (superficial to muscle and fascia)<\/li>\n\n\n\n<li>Debridement of corns and calluses<\/li>\n\n\n\n<li>Trimming and debridement of nails<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Those two words, &#8222;if present&#8220;, carry the coverage rule. You render and document the components the foot needs that day, not all three every time. A patient with no superficial wound does not need one invented to support the claim.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CMS used that conditional deliberately, and only here. G0245 says &#8222;which must include&#8220;. G0246 says &#8222;to include at least the following&#8220;. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Neither carries the qualifier, so their listed elements are mandatory. G0247 is the one LOPS code where the service list flexes with the foot in front of you.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Details<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">G0247<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">HCPCS Level II (G code, CMS-maintained)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Short descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">ROUTINE FOOTCARE PT W LOPS<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Coverage<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicare Part B, with deductible and coinsurance applied<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Eligible providers<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physicians and podiatrists (DPM) billing professionally; hospitals, CAHs, RHCs, and FQHCs billing institutionally<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Same-date requirement<\/td>\n<td style=\"padding:12px 16px;color:#374151\">G0245 or G0246 must appear on the same claim and date of service (Pub 100-04, Ch. 32, &sect;80.2)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Frequency<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No standalone interval for G0247. Its paired evaluation code is payable once every six months<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Revenue code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">940 on institutional claims, except hospitals, which report the revenue center where the service was performed<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-a-monofilament-test-is-what-makes-lops-billable\" class=\"wp-block-heading\">A monofilament test is what makes LOPS billable<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">LOPS means the patient cannot feel pain, pressure, or temperature in the feet, and the record has to prove it. Diabetic peripheral neuropathy causes it. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients cannot feel injuries forming, so ulcers and infections develop unnoticed. Medicare therefore treats this foot care as preventive.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CMS is specific about the test. Test five sites on the plantar surface of each foot with the 5.07 Semmes-Weinstein monofilament, which delivers 10 grams of force. Absence of sensation at two or more of the five sites on either foot confirms peripheral neuropathy with LOPS.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So a patient who feels nothing at three sites on the right foot and one on the left still qualifies. The threshold applies per foot, and one foot can carry it alone.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Two details in the CMS instructions are easy to miss. Test the sites randomly rather than rhythmically, because the loss can be patchy and a rhythm gives the patient clues. Avoid heavily callused areas, since thick skin masks the result.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Then record which sites you tested and which ones failed. Your Medicare Administrative Contractor (MAC) may add detail in its local coverage determination (LCD), so read that before you finalize a documentation template. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">LOPS from a non-diabetic condition, such as hereditary neuropathy, does not qualify here, and the note has to carry the diabetes diagnosis alongside the neuropathy.<\/p>\n\n\n\n<h2 id=\"h-six-conditions-medicare-checks-before-it-pays\" class=\"wp-block-heading\">Six conditions Medicare checks before it pays<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare pays G0247 when six conditions hold at the same time. Miss one and the claim denies, so settle each of them before it goes out.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Confirmed diabetes diagnosis:<\/strong> Type 1, Type 2, or other specified diabetes, documented in the record and carried on the claim as an ICD-10 code.<\/li>\n\n\n\n<li><strong>Documented LOPS:<\/strong> The monofilament result, with the tested sites named, sitting in the visit note.<\/li>\n\n\n\n<li><strong>A same-date G0245 or G0246:<\/strong> The qualifying evaluation on the same claim and date of service, accepted as payable.<\/li>\n\n\n\n<li><strong>No routine foot care paid recently:<\/strong> A routine foot care CPT code paid in the prior six months makes the LOPS codes reject. Those codes are <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11055\/\">11055<\/a> to 11057 and <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11719\/\">11719<\/a> to 11721.<\/li>\n\n\n\n<li><strong>Physician or qualified provider:<\/strong> The treating provider meets the eligibility rules that apply to the LOPS codes in your jurisdiction.<\/li>\n\n\n\n<li><strong>No excluding conditions:<\/strong> Coverage does not extend to foot problems caused independently by another systemic illness.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Turn that list into a pre-visit check rather than an appeal argument. Whether it lives in a <a href=\"https:\/\/pabau.com\/features\/compliance-management-software\/\">compliance checklist<\/a> or on a printed sheet, work through it while the patient is in the room.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/uploads\/hipaa-compliance.png\" alt=\"HIPAA compliance in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau stores LOPS exam records under HIPAA-compliant access controls, so a G0247 note is still audit-ready when a reviewer asks for it years later.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-g0245-and-g0246-are-the-codes-g0247-travels-with\" class=\"wp-block-heading\">G0245 and G0246 are the codes G0247 travels with<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The three LOPS codes are not a sequence you work through over months. G0245 and G0246 are the evaluation codes. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">G0247 is the routine care that has to travel with one of them on the same claim. A G0247 line on its own has nothing to attach to, whatever the patient&#8217;s history shows.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Purpose<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CMS frequency rule<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G0245<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial evaluation and management of a diabetic foot with LOPS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The first LOPS evaluation, covering the diagnosis, history, physical exam, and patient education<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Payable no more than once every six months, counted together with G0246<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G0246<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Follow-up evaluation and management of the same patient<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A later evaluation repeating the history, exam elements, and patient education<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Payable no more than once every six months, counted together with G0245<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G0247<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Routine foot care for a diabetic patient with LOPS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The same date of service as a payable G0245 or G0246, with the components rendered that are present<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No interval of its own. It follows whichever evaluation code it is billed with<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The manual leaves no room here. Section 80.2 says G0247 must be billed on the same date of service as G0245 or G0246 to be considered for payment. Section 80.6 turns that into a claim edit, which denies G0247 when neither code is on the claim.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Common Working File (CWF) applies the same test. It pays G0247 only once the same-day evaluation is accepted as payable.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Denials from this edit come back with claim adjustment reason code 107, the related or qualifying service was not identified on this claim. The patient&#8217;s summary notice shows MSN 21.21. When 107 turns up on diabetic foot care claims, the fix is a billing one rather than a clinical one.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Pull every paid G0247 line from the last quarter. Check each one for a G0245 or G0246 on the same claim and date. Practices that bill routine care on its own between evaluations tend to build up a run of unpayable visits before anyone reads the reason code.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-routine-foot-care-cpt-codes-block-the-lops-codes\" class=\"wp-block-heading\">Routine foot care CPT codes block the LOPS codes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A routine foot care CPT code paid in the prior six months makes G0247 reject, along with G0245 and G0246. The two families cannot share a six-month window.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The reasoning sits in the manual. Once a patient&#8217;s condition progresses far enough for routine foot care to become covered on its own, Medicare stops paying for LOPS evaluation and management. From that point you bill the routine foot care codes instead.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">What it covers<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Effect on G0247<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11055, 11056, 11057<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Paring or cutting of benign hyperkeratotic lesions, split by single lesion, two to four, and more than four<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Payment within the prior six months causes CWF to reject G0245, G0246, and G0247<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11719<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Trimming of nondystrophic nails, any number<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Payment within the prior six months causes CWF to reject the LOPS codes<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">11720, 11721<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Debridement of nails by any method, one to five nails and six or more nails<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Payment within the prior six months causes CWF to reject the LOPS codes<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">One common mistake belongs here rather than with the G codes. Many MAC local coverage determinations expect at least 60 days between nail debridement services billed with 11720 or 11721. That interval governs those CPT codes, so keep it out of a diabetic foot care recall schedule.<\/p>\n\n\n\n<h2 id=\"h-the-diagnosis-code-decides-whether-the-claim-pays\" class=\"wp-block-heading\">The diagnosis code decides whether the claim pays<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CMS pays the LOPS codes only when the claim carries a diabetes-with-neuropathy diagnosis. This edit is national rather than a local variation. A general diabetes code, with no neuropathy detail, fails it.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">E11.40<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Type 2 diabetes mellitus with diabetic neuropathy, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The most commonly reported option on LOPS claims<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">E11.42<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Type 2 diabetes mellitus with diabetic polyneuropathy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when polyneuropathy is documented<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">E10.40<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Type 1 diabetes mellitus with diabetic neuropathy, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The Type 1 equivalent of E11.40<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">E13.40<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other specified diabetes mellitus with diabetic neuropathy, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">For diabetes that is neither Type 1 nor Type 2, and not drug induced<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">E08.40<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Diabetes mellitus due to an underlying condition with diabetic neuropathy, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Code the underlying condition first<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">E09.40<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The correct choice for drug-induced diabetes, which is often miscoded as E13.40<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The CMS list runs wider than the six codes above. For the E10, E11, and E13 families it also carries the mononeuropathy, autonomic, amyotrophy, other-complication, and arthropathy codes. For E08 and E09, only the unspecified neuropathy and polyneuropathy codes appear.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So check the current version before you build a favorites panel. The <a href=\"https:\/\/www.cms.gov\/regulations-and-guidance\/guidance\/manuals\/downloads\/clm104c32.pdf\" target=\"_blank\" rel=\"nofollow noopener\">CMS Chapter 32 manual<\/a> and your MAC&#8217;s LCD update on their own cycles.<\/p>\n\n\n\n<h2 id=\"h-documentation-that-survives-a-lops-audit\" class=\"wp-block-heading\">Documentation that survives a LOPS audit<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Two problems account for most G0247 audit findings. The note asserts LOPS with no test result behind it, or it records the routine care without the same-day evaluation that makes it payable. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/medical-forms-at-your-healthcare-practice\/\">Standardized medical forms<\/a> built around these requirements close most of that at the point of documentation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Each chart note for a G0247 visit should include the following:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>LOPS confirmation method:<\/strong> Record the test used, the sites tested, and which sites had no sensation. Two failures out of five per foot is the threshold CMS describes.<\/li>\n\n\n\n<li><strong>Diabetes diagnosis reference:<\/strong> Document the diagnosis in the note, or point to the problem list entry that carries it.<\/li>\n\n\n\n<li><strong>Services rendered:<\/strong> Describe each component you performed. Where one of the three was not clinically indicated, say so, since the descriptor asks only for what is present.<\/li>\n\n\n\n<li><strong>The paired evaluation:<\/strong> Show that the G0245 or G0246 encounter happened on the same date, with its own required elements documented.<\/li>\n\n\n\n<li><strong>Provider credentials:<\/strong> The provider&#8217;s name, credentials, and NPI need to be identifiable in the note.<\/li>\n\n\n\n<li><strong>Date of service:<\/strong> The note carries the date of the visit rather than a later date.<\/li>\n\n\n\n<li><strong>Medical necessity statement:<\/strong> Connect the LOPS finding to the care you delivered that day.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In a <a href=\"https:\/\/pabau.com\/industry\/gp-clinic-software\/\">primary care practice<\/a>, the LOPS exam usually sits inside a longer diabetic review. The monofilament grid needs a place of its own in the note. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">Digital intake forms<\/a> can pre-populate that grid and the service fields, which lets providers complete them during the visit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\">HIPAA-compliant documentation<\/a> then keeps those records retrievable and intact for the length of an audit window.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-g0247\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>A custom form in Pabau can carry the five-site monofilament grid, so the LOPS result lands in the record during the visit.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-what-medicare-pays-and-what-the-patient-owes\" class=\"wp-block-heading\">What Medicare pays, and what the patient owes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare pays 80 percent of the lesser of the fee schedule amount or your actual charge. The patient covers the rest through the Part B deductible and 20 percent coinsurance.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Say the allowed amount is $500 and the patient has already met the deductible for the year. Medicare pays $400, and the patient owes $100. If the deductible is still open, it comes off first, so the patient pays more.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The rate itself moves every year. CMS sets it in the Physician Fee Schedule final rule, building it from relative value unit (RVU) components and the annual conversion factor. A geographic practice cost index (GPCI) then adjusts the figure for your locality.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Institutional settings work differently. Hospital outpatient departments fall under the Outpatient Prospective Payment System (OPPS). Rural health clinics and federally qualified health centers receive an all-inclusive rate instead.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Because the figures move and differ by locality, look yours up in the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS fee schedule tool<\/a>. Facility rates, where you bill the professional component only, sit below non-facility rates.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Rate type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">What it reflects<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Where to confirm<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Non-facility rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Service rendered in a physician&#8217;s office or private practice setting<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS PFS lookup tool, filtered by locality<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Facility rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Service rendered in a hospital outpatient or facility setting<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS PFS lookup tool, filtered by locality<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Geographic adjustment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">GPCI modifier applied to the practice&#8217;s region<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS locality codes by MAC jurisdiction<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Rates are the easy part of this code. Most of the money at stake turns on how you assemble the claim.<\/p>\n\n\n\n<h2 id=\"h-how-to-bill-g0247-step-by-step\" class=\"wp-block-heading\">How to bill G0247, step by step<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">G0247 needs more checkpoints than a standard <a href=\"https:\/\/pabau.com\/blog\/medicare-billing\/\">Medicare billing<\/a> workflow, and most of them look at payment history rather than the chart. Work through them in this order.<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Confirm the diagnosis and the LOPS finding:<\/strong> The patient needs a documented diabetes diagnosis and a recorded monofilament result before G0247 applies.<\/li>\n\n\n\n<li><strong>Check the evaluation window:<\/strong> G0245 and G0246 are payable once every six months between them. Find the last paid date, because that sets when you can bill the next paired visit.<\/li>\n\n\n\n<li><strong>Check for paid routine foot care codes:<\/strong> 11055 to 11057 or 11719 to 11721 paid in the prior six months makes the LOPS codes reject. Bill the routine foot care CPT codes instead.<\/li>\n\n\n\n<li><strong>Render and document what is present:<\/strong> Treat the wounds, corns, calluses, and nails that need attention. Note why any component was not indicated.<\/li>\n\n\n\n<li><strong>Attach a covered diagnosis code:<\/strong> Use a diabetes-with-neuropathy code from the CMS list, such as <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-e1140\/\">E11.40<\/a>, and check it against your MAC&#8217;s LCD.<\/li>\n\n\n\n<li><strong>Bill G0247 on the same claim and date as the evaluation:<\/strong> Submit G0245 or G0246 alongside it. On its own, G0247 denies with reason code 107.<\/li>\n\n\n\n<li><strong>Submit under the right provider and track the remittance:<\/strong> Check the rendering NPI against eligible provider types, then read the remittance advice. Documentation denials are often correctable on first appeal.<\/li>\n<\/ol>\n\n\n\n<h3 id=\"h-before-and-after-you-hit-submit\" class=\"wp-block-heading\">Before and after you hit submit<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">A steady diabetic foot care caseload is where <a href=\"https:\/\/pabau.com\/features\/automated-workflows-software\/\">automated workflows<\/a> earn their place. They prompt the required fields and surface the recall date for the next evaluation before anyone books the visit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Most practices send claims through a <a href=\"https:\/\/pabau.com\/blog\/medical-claims-clearinghouse\/\">claims clearinghouse<\/a>, which returns format rejections within hours. A 107 denial comes from Medicare itself, so watch the remittance rather than the clearinghouse report.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-g0247\/automated-communication-in-pabau.webp\" alt=\"Automated communication in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automated recalls in Pabau bring diabetic foot care patients back when their six-month evaluation window reopens and a paired G0247 becomes payable.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-why-these-claims-deny-and-how-to-get-ahead-of-it\" class=\"wp-block-heading\">Why these claims deny, and how to get ahead of it<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Six patterns cover almost every G0247 denial. Four of them come straight from the CMS manual, so they are predictable rather than discretionary. The other two are documentation habits.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Denial reason<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Root cause<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Prevention action<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">No qualifying diagnosis on the claim<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A diabetes code was submitted without the diabetic neuropathy detail CMS requires<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pair every LOPS claim with a code from the CMS list, such as E11.40 or E10.40<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G0247 without a same-date evaluation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No G0245 or G0246 on the same claim and date of service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bill the evaluation and the routine care together. This edit returns reason code 107<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Evaluation billed inside six months<\/td>\n<td style=\"padding:12px 16px;color:#374151\">G0245 or G0246 was already paid less than six months earlier, for any provider<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Check the last paid evaluation date when booking. This edit returns MSN 18.4 and reason code 96<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Routine foot care paid in the prior six months<\/td>\n<td style=\"padding:12px 16px;color:#374151\">11055, 11056, 11057, 11719, 11720, or 11721 was paid within the window<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Review payment history first, then bill the routine foot care CPT codes instead<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LOPS not substantiated<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The note states LOPS but records no monofilament result<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Require the tested sites and the failed sites in every visit note<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Non-covered provider type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The rendering provider is not recognized for the LOPS codes in that jurisdiction<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Verify provider eligibility with your MAC before billing<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Read your MAC&#8217;s LCD next to that table, because local policy can add its own documentation demands. Most of these denials are correctable on appeal, but an appeal costs staff time that a pre-submission check does not.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Sort your G0247 denials by reason code each month rather than by dollar value. Reason code 107 points at a claim assembly problem. Code 96 with remark M86 points at a payment history problem, and a diagnosis denial points at your coding panel. Each one has a different owner.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-how-pabau-keeps-the-lops-exam-and-the-claim-together\" class=\"wp-block-heading\">How Pabau keeps the LOPS exam and the claim together<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most G0247 problems start in the workflow rather than the coding. Nothing in the visit asks for the monofilament result, so it gets skipped. The routine care then ends up recorded away from the evaluation it depends on.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau closes that distance. Treatment-specific digital forms can carry the five-site monofilament grid, so the tested sites and the failures land in the record during the visit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The form, the treatment note, and the appointment all sit on one client record. That gives the evaluation and the routine care a visible shared date of service. Pabau Scribe, our AI scribe, drafts the visit note from the consultation, so clinical detail survives a full appointment book.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Reporting shows which patients are approaching six months since their last LOPS evaluation. Recalls then line up with the window when a paired G0247 becomes payable. <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">Claims management<\/a> keeps the billing record beside the patient file, so nobody reassembles it at submission.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The same setup carries across specialties. A <a href=\"https:\/\/pabau.com\/industry\/metabolic-health-emr\/\">metabolic health practice<\/a> reviewing the same patients works from one documentation standard rather than a workaround. <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">Practice management software<\/a> that connects clinical notes to the billing queue removes the manual handoff where coding errors start.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Keep every G0247 claim beside the visit that supports it                <\/h3>\n\n                <p class=\"description\">\n                    Pabau helps podiatry and primary care practices capture the LOPS exam and keep the evaluation and routine care on one dated record. Recalls bring patients back when the next visit becomes payable.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau practice management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">G0247 rewards a practice that treats billing as part of the visit. The monofilament result, the diagnosis code, the paired evaluation, and the six-month payment history are all knowable before the patient leaves the room.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So build the habit rather than the appeal file. Treat G0247 as a line that travels with its evaluation, and document the components you actually rendered rather than a fixed set of three. Denials on this code are cheap to prevent and slow to argue.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau keeps the LOPS exam, the treatment note, and the billing record on one patient file. A coder can then match a G0247 line to its same-day evaluation in seconds. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how that runs in a podiatry or primary care workflow.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding nail work outside the LOPS benefit?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-g0127\/\">G0127<\/a> covers how trimming of dystrophic nails is reported and when Medicare pays for it.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Paring corns and calluses on more than one lesion?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11056\/\">11056<\/a> explains how lesion counts decide which hyperkeratotic lesion code applies.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding other diabetic preventive services?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-s3000\/\">S3000<\/a> covers the dilated retinal exam reported for patients with diabetes.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Choosing software for a podiatry caseload?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/practice-management-software-podiatry\/\">Podiatry practice software<\/a> compares the platforms podiatry practices run their scheduling and billing on.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Building the education part of a diabetic foot visit?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/patient-education\/\">Patient education<\/a> covers the materials and delivery methods that get patients to act on advice.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1787000000001\"><h3 class=\"schema-faq-question\">Isn&#8217;t routine foot care excluded from Medicare?<\/h3> <p class=\"schema-faq-answer\">As a rule, yes. Peripheral neuropathy with LOPS counts as a localized illness of the feet, and the regulation at 42 CFR 411.15(l)(1)(i) exempts that from the exclusion. The LOPS codes exist to carry the exception.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787000000002\"><h3 class=\"schema-faq-question\">Does a visit to another foot care specialist affect coverage?<\/h3> <p class=\"schema-faq-answer\">It can. CMS covers the LOPS evaluation every six months. That holds only if the patient has not seen a foot care specialist for some other reason in between. Ask about outside podiatry visits when you book.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787000000003\"><h3 class=\"schema-faq-question\">Why did our rural health clinic claim with revenue code 940 deny?<\/h3> <p class=\"schema-faq-answer\">Revenue code 940 pays only when the claim also carries a visit revenue code, 520 or 521. Rural health clinics and federally qualified health centers report the LOPS codes on bill type 71X or 73X.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787000000004\"><h3 class=\"schema-faq-question\">Does the six-month clock run on the date of service or the paid date?<\/h3> <p class=\"schema-faq-answer\">The dates of service set the interval, and only a paid claim starts it. The Common Working File rejects a second evaluation less than six months after a paid one, whoever furnished it.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787000000005\"><h3 class=\"schema-faq-question\">Can a facility and a physician both bill for the same LOPS visit?<\/h3> <p class=\"schema-faq-answer\">On bill types 13X and 85X, yes. The Common Working File posts one claim as technical and the other as professional, so the second is not a duplicate. Rural health clinic and health center claims do reject against an exact match.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>HCPCS code G0247 covers routine foot care for a diabetic patient with loss of protective sensation, known as LOPS. Medicare accepts G0247 only when the evaluation code it belongs with, G0245 or G0246, sits on the same claim and date of service. Everything below follows the CMS Medicare Claims Processing Manual, Publication 100-04, Chapter 32, [&hellip;]<\/p>\n","protected":false},"author":85,"featured_media":181340,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"81","_yoast_wpseo_content_score":"90","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1548],"tags":[2395,2517,2949,4156,3372],"class_list":["post-181341","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-hcpcs","tag-medicare-billing","tag-medicare-frequency-limits","tag-medicare-hcpcs-codes","tag-podiatry","tag-podiatry-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>HCPCS code G0247: How to bill routine foot care for LOPS<\/title>\n<meta name=\"description\" content=\"G0247 covers routine diabetic foot care with LOPS, but it never pays alone. 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Rural health clinics and federally qualified health centers report the LOPS codes on bill type 71X or 73X.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-g0247\/#faq-question-1787000000004","position":4,"url":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-g0247\/#faq-question-1787000000004","name":"Does the six-month clock run on the date of service or the paid date?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The dates of service set the interval, and only a paid claim starts it. The Common Working File rejects a second evaluation less than six months after a paid one, whoever furnished it.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-g0247\/#faq-question-1787000000005","position":5,"url":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-g0247\/#faq-question-1787000000005","name":"Can a facility and a physician both bill for the same LOPS visit?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"On bill types 13X and 85X, yes. The Common Working File posts one claim as technical and the other as professional, so the second is not a duplicate. Rural health clinic and health center claims do reject against an exact match.","inLanguage":"de"},"inLanguage":"de"}]}},"yoast":{"focus_keyword":"HCPCS code G0247","seo_title":"HCPCS code G0247: How to bill routine foot care for LOPS","meta_description":"G0247 covers routine diabetic foot care with LOPS, but it never pays alone. Find out which same-date code it needs.","content_score":"90","is_cornerstone":"","related_keyphrases":[{"keyword":"diabetic foot care Medicare coverage","score":56},{"keyword":"loss of protective sensation billing","score":61},{"keyword":"G0247 documentation requirements","score":61}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/posts\/181341","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/users\/85"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/comments?post=181341"}],"version-history":[{"count":4,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/posts\/181341\/revisions"}],"predecessor-version":[{"id":183187,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/posts\/181341\/revisions\/183187"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/media\/181340"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/media?parent=181341"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/categories?post=181341"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/tags?post=181341"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}