HCPCS Code G0247: Routine Foot Care for Diabetic Patients with LOPS

Key takeaways

HCPCS code G0247 covers routine foot care for diabetic patients with confirmed loss of protective sensation (LOPS). That means wound care, corn and callus debridement, and nail trimming.

The CMS descriptor says these components are included if present, so you render and document only the ones clinically indicated at that visit.

G0247 is never independently billable. CMS pays it only when G0245 or G0246 is accepted on the same claim and date of service.

G0247 has no frequency limit of its own. The evaluation codes it rides on, G0245 and G0246, are payable once every six months per patient.

Practice management software like Pabau keeps the evaluation, the treatment note, and the billing record on one dated patient file. That makes the same-date pairing easy to confirm before submission.

Routine foot care denials cost podiatry and primary care practices thousands of dollars each year. Two problems account for most of them. Loss of protective sensation gets stated in the note but never clinically substantiated, and G0247 gets submitted on its own.

HCPCS code G0247 is not independently billable. Medicare pays it only when G0245 or G0246 sits on the same claim and date of service. The three listed service components are required only if they are present. Getting those two rules right removes most diabetic foot care rejections. Claims management software built for medical practices helps by keeping the evaluation and the routine care on one record.

Everything below follows the CMS Medicare Claims Processing Manual, Publication 100-04, Chapter 32, Section 80. Confirm any workflow change with a certified medical biller or your compliance officer before you roll it out.

HCPCS code G0247: Definition and code details

HCPCS code G0247 describes routine foot care by a physician for a diabetic patient with diabetic sensory neuropathy resulting in loss of protective sensation (LOPS). The long descriptor maintained by CMS under the Healthcare Common Procedure Coding System (HCPCS) reads “to include if present, at least the following”:

• Local care of superficial wounds (superficial to muscle and fascia)
• Debridement of corns and calluses
• Trimming and debridement of nails

Those two words, “if present”, carry the whole coverage rule. You render and document the components that are clinically indicated at that visit, not all three every time. A patient with no superficial wound does not need one invented to support the claim.

CMS used the conditional deliberately, and only here. G0245 says “which must include” and G0246 says “to include at least the following”. 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.

What is loss of protective sensation (LOPS)?

Loss of protective sensation is the inability to perceive pain, pressure, or temperature stimuli in the feet, caused by diabetic peripheral neuropathy. Patients with LOPS cannot feel injuries forming, so ulcers, infections, and structural damage develop unnoticed. That is why Medicare treats professional foot care here as preventive rather than cosmetic.

CMS is specific about how LOPS is confirmed. 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. Test the sites randomly rather than rhythmically, since the loss can be patchy and a predictable rhythm gives the patient clues.

Avoid heavily callused areas when you test, because thick skin masks the result. Record which sites you tested and which ones failed. Your MAC’s local coverage determination (LCD) may add detail, so check it before you finalize a documentation template.

LOPS caused by non-diabetic conditions, such as hereditary neuropathy, does not qualify for coverage under this benefit. The diabetes diagnosis has to be present and documented alongside the neuropathy.

Medicare coverage criteria for diabetic foot care under G0247

Medicare Part B covers HCPCS code G0247 when all of the following conditions are met. Missing one of them is enough to trigger a denial, so each needs to be settled before the claim goes out.

• Confirmed diabetes diagnosis: A Type 1, Type 2, or other specified diabetes diagnosis must be documented and carried on the claim as an ICD-10 code.
• Documented LOPS: The clinical basis for LOPS, normally the 5.07 monofilament result with the tested sites named, must appear in the record.
• A same-date G0245 or G0246: The qualifying evaluation must be on the same claim and date of service, and must be accepted as payable.
• No routine foot care paid recently: CMS rejects the LOPS codes when a routine foot care CPT code was paid in the prior six months. The codes are 11055 to 11057 and 11719 to 11721.
• Physician or qualified provider: The treating provider must meet the eligibility requirements that apply to the LOPS codes in your jurisdiction.
• No excluding conditions: Coverage does not extend to foot conditions caused independently by another systemic illness.

Practices using compliance management tools can turn that list into a pre-visit checklist. Each criterion gets confirmed while the patient is still in the room, not at appeal.

G0245, G0246, and G0247: How the three LOPS codes work together

The three diabetic foot care G codes are not a sequence you work through over months. G0245 and G0246 are the evaluation codes, and 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’s history shows.

The manual is blunt about it. Section 80.2 states that G0247 must be billed on the same date of service with either G0245 or G0246 to be considered for payment. Section 80.6 turns that into a claim edit: deny G0247 if it is not submitted on the same claim as G0245 or G0246. The Common Working File applies the same test, paying G0247 only once the same-day evaluation is accepted as payable.

Denials from this edit come back with claim adjustment reason code 107, the related or qualifying service was not identified on this claim. If you see 107 on diabetic foot care claims, the fix is a billing one rather than a clinical one.

G0247 and the routine foot care CPT codes

The LOPS codes and the standard routine foot care CPT codes cannot share a six-month window. Medicare stops paying for LOPS evaluation and management once a patient’s condition progresses far enough that routine foot care is covered in its own right. From then on you bill the routine foot care codes instead.

This is also where the well-known 60-day interval belongs. Many MAC local coverage determinations expect at least 60 days between nail debridement services billed with 11720 or 11721. That guideline governs those CPT codes, not G0247, so do not carry it across when you build a diabetic foot care recall schedule.

Required ICD-10 diagnosis codes for HCPCS code G0247

The diagnosis requirement here is national, not a local variation. CMS instructs contractors to allow payment for G0245, G0246, and G0247 only when the claim carries one of the listed diabetes-with-neuropathy codes. A general diabetes code without the neuropathy detail is denied under that edit.

The CMS list also includes the mononeuropathy, autonomic neuropathy, amyotrophy, and neuropathic arthropathy codes in each of those families. Check the current version before you build a favorites panel. The CMS annual HCPCS code list and your MAC’s LCD update on their own cycles.

Documentation requirements for G0247

G0247 audit findings cluster around two problems. Either LOPS is asserted with no test result behind it, or the routine care is documented without the same-day evaluation that makes it payable. Standardized medical forms built around these requirements close most of that at the point of documentation.

Each chart note for a G0247 visit should include the following:

• LOPS confirmation method: 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.
• Diabetes diagnosis reference: Document the diagnosis in the note or point to the problem list entry that carries it.
• Services rendered: Describe each component you performed. Where one of the three was not clinically indicated, say so, because the descriptor only asks for what is present.
• The paired evaluation: Show that the G0245 or G0246 encounter happened on the same date, with its own required elements documented.
• Provider credentials: The provider’s name, credentials, and NPI need to be clearly identifiable in the note.
• Date of service: The note must be dated to the day of service rather than backdated later.
• Medical necessity statement: Connect the LOPS finding to the care you actually delivered that day.

Practices that use digital intake forms can pre-populate the monofilament grid and the service fields. Providers then complete them during the visit instead of reconstructing them afterwards. HIPAA-compliant documentation practices then keep those records retrievable and intact for the length of an audit window.

G0247 fee schedule and Medicare reimbursement in 2026

Medicare reimbursement for HCPCS code G0247 is set annually in the CMS Physician Fee Schedule final rule and varies by location. National payment amounts come from relative value unit (RVU) components multiplied by the annual conversion factor. A geographic practice cost index (GPCI) then adjusts that figure for your jurisdiction.

Medicare pays 80 percent of the lesser of the fee schedule amount or the actual charge, and the Part B deductible and coinsurance both apply. Institutional settings work differently. Hospital outpatient departments are paid under OPPS, while rural health clinics and federally qualified health centers are paid an all-inclusive rate.

Because dollar figures move each year and differ across localities, look up your current amount directly in the CMS Physician Fee Schedule lookup tool. Facility rates, where the practice bills the professional component only, sit below non-facility rates.

The AAPC HCPCS code lookup carries a fee schedule reference for G0247 too, though the CMS tool remains the authoritative source for final billing rates.

How to bill G0247: Step-by-step process

Billing G0247 has more checkpoints than a standard office visit code, and most of them are payment-history checks rather than clinical ones. Work through them in this order.

1. Confirm the diagnosis and the LOPS finding: The patient needs a documented diabetes diagnosis and a recorded monofilament result before G0247 applies.
2. Check the evaluation window: G0245 and G0246 are payable once every six months between them. Find the last paid date, because that is what determines when the next paired visit can be billed.
3. Check for paid routine foot care codes: 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.
4. Render and document what is present: Treat the wounds, corns, calluses, and nails that need attention. Note why any component was not indicated.
5. Attach a covered diagnosis code: Use a diabetes-with-neuropathy code from the CMS list, such as E11.40, and confirm it against your MAC’s LCD.
6. Bill G0247 on the same claim and date as the evaluation: Submit G0245 or G0246 alongside it. On its own, G0247 denies with reason code 107.
7. Submit under the right provider and track the remittance: Check the rendering NPI against eligible provider types, then watch for the remittance advice. Documentation-related denials are often correctable on first appeal.

Practices with a steady diabetic foot care caseload benefit from automated workflows. These prompt the required fields and surface the recall date for the next evaluation before a visit is booked.

Common G0247 claim denials and how to prevent them

Four of the denial edits below come straight from the CMS manual, so they are predictable rather than discretionary. The other two are documentation habits. Address them before submission rather than on appeal.

Reading your MAC’s local coverage determination alongside a primary care compliance framework gives you the fuller denial risk picture. Because these denials are often correctable, audit-ready documentation from day one is the cheaper route.

How Pabau keeps G0247 documentation audit-ready

Most G0247 problems start in the workflow rather than the coding. The monofilament result gets skipped because nothing asks for it, and the routine care ends up recorded separately from the evaluation it depends on.

Pabau is an all-in-one practice management system, and the fix here is largely a documentation one. Treatment-specific digital forms can carry the five-site monofilament grid. The tested sites and the failures get captured while the patient is still in the chair. The form, the treatment note, and the appointment all sit on one client record. The evaluation and the routine care therefore share a visible date of service.

Pabau Scribe, our AI scribe, drafts the visit note from the consultation, so clinical specificity survives a full appointment book. 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. Claims management keeps the billing record beside the patient file, so nothing has to be reassembled at submission.

The same setup carries across specialties. A physical therapy or allied health practice treating diabetic patients works from one documentation standard rather than a workaround. Practice management software that connects clinical notes to the billing queue removes the manual handoff where most coding errors begin.

Keep every G0247 claim beside the visit that supports it

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.

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Conclusion

G0247 denials follow a short list of patterns. Maybe the monofilament result is missing, or the diagnosis code lacks the neuropathy detail. Sometimes the evaluation code is not on the same claim, or a routine foot care CPT code was paid inside the last six months. All four are visible before the claim leaves the practice.

The habit worth building is simple. Treat G0247 as a line that travels with its evaluation, and document the components you actually rendered rather than a fixed set of three.

Pabau’s claims management software keeps the LOPS exam, the treatment note, and the billing record on one patient file. A coder can check a G0247 line against its same-day evaluation in seconds. To see how that runs in a podiatry or primary care workflow, book a demo.

Continue your research

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