Treatment FAQ

under what circumstances does medicare cover laser treatment for finger nail fungus

by Rubye Kiehn Published 3 years ago Updated 2 years ago

Insurance Coverage Insurance companies consider laser therapy a cosmetic procedure and do not cover the service. Most insurance carriers will, however, cover your initial visit for evaluation and diagnosis of your nail problem.

Medicare will cover treatment for fungus within your toenail. Another term for this treatment is nail debridement. To be eligible, you must have severe, debilitating pain. Evidence of several infections caused by the fungus may also qualify you.Sep 30, 2021

Full Answer

Does Medicare cover nail fungus treatment?

 · How Medicare Can Help Medicare Part B (Medical Insurance) may help cover medically necessary services, including doctor visits and care you receive in an outpatient setting, to diagnose and treat infections such as toenail fungus. If you have Original Medicare, you would likely pay 20% of the Medicare-approved amount and the Part B deductible will apply.

Do laser treatments for nail fungus work?

 · Medicare may cover nail fungus treatment if it’s determined to be medically necessary foot care. According to the Mayo Clinic, nail fungus may lead to a serious infection that spreads beyond your feet if you have a suppressed immune system. People with diabetes are particularly at risk for complications from nail fungus.

Does Medicare cover nail trimming?

 · For a special treatment that includes exfoliation, nail and cuticle trimming, fungus prevention, and maybe even a foot massage, the average cost across the country is about $35.00 to $40.00. If you choose to visit a nail salon, be sure that it is a reputable one, your pedicurist is experienced, and that the equipment they use is sterilized.

What is the treatment for nail fungus?

 · Laser Therapy for nail fungus is expensive, elective and cosmetic. Another detriment of nail fungus laser therapy is cost. The expense is usually not covered by insurance because toenail fungus is deemed a cosmetic issue, not a serious health matter. Treatment is elective and based more on the appearance of the feet than an actual health threat.

How many laser treatments are needed for nail fungus?

How many sessions will be needed? To achieve optimal results, we recommend a series of 3 – 4 treatment sessions, spaced 5 – 6 weeks apart. This is essential to eradicate all fungi spores that may bloom after your initial treatment. However, significant improvement is usually seen after one treatment.

Does insurance cover fungal nail treatment?

For patients with health insurance, the typical out-of-pocket cost for foot fungus treatment consists of a copay or coinsurance of 10%-50%. Foot fungus treatment at a doctor's office and prescription medications typically are covered by health insurance, depending on the plan.

Is nail debridement covered by Medicare?

Medicare will cover debridement of nail(s) by any method(s); 1 to 5 and/or debridement of nail(s) by any method(s); 6 or more no more often than every 60 days.

What is the best laser treatment for nail fungus?

Fungal infections of the nails usually require several laser treatment sessions before they completely resolve. ... For this type of treatment, CO2 lasers or yttrium-aluminum-garnet (YAG) lasers with wavelengths of 870 nm, 930 nm, or 1320 nm are used to increase the localized temperature.More items...•

Does insurance cover laser nail fungus?

The laser procedure for nail fungus is not covered by any insurance. You may, however, often user your flexible spending account or medical savings account to (14)… Nail fungus, or onychomycosis, is a fungal infection that causes the nails to grow thick, discolored and brittle.

Does insurance cover laser fungus removal?

Toenail laser therapy is the most effective way to eliminate a fungal nail infection. Unfortunately, this procedure is currently not covered by medical insurance since it is considered “aesthetic.” However, there are ways you can help manage the cost of a laser therapy.

How often does Medicare pay for nail care?

once every 61 daysMedicare will cover the treatment of corns, calluses, and toenails once every 61 days in persons having certain systemic conditions. Examples of such conditions include: Diabetes with peripheral arterial disease, peripheral arterial disease, peripheral neuropathy, and chronic phlebitis.

What does nail debridement mean?

Nail debridement involves the removal of a diseased toenail bed or viable nail plate. This may be performed manually with an instrument, or with an electric grinder. Podiatrists generally provide nail debridement to patients diagnosed with onychomycosis (i.e., mycosis or mycotic toenails).

Is CPT 11721 covered by Medicare?

Debridement of Nail Coding Criteria Procedure Code 11720 or 11721 are included in Medicare's covered foot care when billed with a diagnosis pertaining to debridement of nail.

Does laser treatment cure nail fungus?

A 2019 study published in the journal American Family Physician by the American Association of Family Physicians found that after 180 days of toenail fungus laser treatment, patients had a 30% cure rate and a 91% improvement in symptoms.

Do home nail fungus lasers work?

The treatments vary by the company and by each individual doctor. As a result, there have been no solid studies to prove that the laser can cure toenail fungus. As a matter of fact, the FDA clearance for laser machines states that it is for “temporary increase of clear nail in patients with onychomycosis.”

How effective is laser treatment for onychomycosis?

In general, the analysis revealed that the efficacy of laser treatment of onychomycosis was approximately 63%. In comparison, the mycological efficacy of itraconazole pulse therapy and continuous terbinafine therapy for the treatment of onychomycosis were 79.6% and 84.8%, respectively.

Does Medicare cover nail fungus?

Medicare covers limited podiatry. Medicare may cover nail fungus treatment if it’s determined to be medically necessary foot care. According to the Mayo Clinic, nail fungus may lead to a serious infection that spreads beyond your feet if you have a suppressed immune system.

How to find out if a prescription drug covers nail fungus?

To find out if your prescription drug plan covers nail fungus medication, check the plan’s formulary, or list of covered medications. The formulary may change at any time, but the plan will inform you when necessary. Medicare Part D prescription drug plans do not usually cover over-the-counter medications such as over-the-counter nail fungus creams ...

Does Medicare cover foot care?

In other people, nail fungus could be a mild condition causing no problem beyond the cosmetic. Medicare does not generally cover routine foot care, including removal of corns and calluses or trimming of toe nails.

Can nail fungus cause a thickening of the fingernails?

Last Updated : 09/10/2018 3 min read. If you have nail fungus, you’re not alone. According to the Mayo Clinic, nail fungus is common, especially in older adults. Nail fungus results in nails that are thickened, discolored, brittle and ragged, and slightly foul smelling. Nail fungus can affect the fingernails, but it’s more common in the toenails.

Is nail fungus common in older adults?

According to the Mayo Clinic, nail fungus is common, especially in older adults. Nail fungus results in nails that are thickened, discolored, brittle and ragged, and slightly foul smelling. Nail fungus can affect the fingernails, but it’s more common in the toenails. Find affordable Medicare plans in your area. Find Plans.

What does nail fungus mean?

Nail fungus results in nails that are thickened, discolored, brittle and ragged, and slightly foul smelling. Nail fungus can affect the fingernails, but it’s more common in the toenails. Find affordable Medicare plans in your area. Find Plans. Find Medicare plans in your area.

Can nail fungus come back?

What is nail fungus treatment? According to the Mayo Clinic, nail fungus can be difficult to treat and even after successful treatment nail fungus often comes back.

Does Medicare cover nail trimming?

If you are covered by Original Medicare Part B (medical insurance) or have a Medicare Advantage (Part C) policy, you may have coverage for nail trimming and other types of foot care. While Medicare Part B insurance does not generally cover routine foot care services which may include toenail clipping or corn and callus removal, ...

How to keep nail trimmers clean?

shower. • Keep all your trimming tools clean by washing or wiping them with rubbing alcohol. • Make sure your hands and feet are clean before and after trimming. • Cut your toenails straight across, do not cut into the curve around the end of the nail. • Avoid cutting the skin and do not cut calluses.

Why is it so hard to cut your fingernails?

As people get older, paying attention to good health and hygiene becomes even more important. Simple routine tasks, like cutting your fingernails and toenails, can become difficult or even impossible if you have impaired vision or a problem with mobility.

Why is it important to trim your toenails?

Why Proper Toenail Trimming is Important. If your toenails are not taken care of, they may cause injury by scratching or puncturing your skin, breaking off and exposing delicate skin under the nail, or by tearing off because of snagging on clothing or other materials .

Why is it important to take care of your toes and toes?

They become more difficult to cut and more prone to fungal infections. If you have diabetes, it is even more important for you to care for feet and toenails meticulously. Toes and feet are very susceptible to diabetic nerve damage making them more vulnerable to injuries.

Is laser treatment for toenail fungus covered by insurance?

Another detriment of nail fungus laser therapy is cost. The expense is usually not covered by insurance because toenail fungus is deemed a cosmetic issue, not a serious health matter. Treatment is el ective and based more on the appearance of the feet than an actual health threat. The cosmetic side of nail fungus is perturbing to those who have it. Symptoms of nail fungus include distortion of the nail surface, including a brittle or ridged appearance, discoloration of the nail surface (usually a dull yellow color) and brittle-looking or crumbling nails. But it is rarely a dangerous condition.

Is laser treatment for nail fungus expensive?

Laser Therapy for Nail Fungus Is Expensive, Elective and Cosmetic. Another detriment of nail fungus laser therapy is cost. The expense is usually not covered by insurance because toenail fungus is deemed a cosmetic issue, not a serious health matter. Treatment is elective and based more on the appearance of the feet than an actual health threat.

Is nail fungus a common malady?

Nail fungus, particularly in the toenails, is a common malady among older persons and laser therapy is being used as a treatment but is it worth it? Dermatologist B.E. Elewski says that merely being over 60 years of age is a risk factor for this type of fungus. It is wise for elderly persons to use effective treatments, ...

How long does it take for a nail ointment to work?

Topical ointments may take months to work. Removal of the nail or a portion is painful and takes a long time for growth of the nail. Recurrence and reinfection are common. Laser treatment of nail fungus, which was approved by the FDA in 2010, penetrates the nail plate and kills fungi underneath.

Does laser treatment kill fungus?

Removal of the nail or a portion is painful and takes a long time for growth of the nail. Recurrence and reinfection are common. Laser treatment of nail fungus, which was approved by the FDA in 2010, penetrates the nail plate and kills fungi underneath. Advocates of laser therapy for toenail fungus say the procedure is fast, ...

Can nail fungus be recurred?

However, the authors of the literature review acknowledged that reinfection is so common with nail fungus that it is possible that reinfection, not recurrence of the original infection, was responsible for the unpersuasive results. Another study, published in the Journal of the American Academy of Dermatology, noted that laser treatment did not ...

Is toenail fungus covered by insurance?

The expense is usually not covered by insurance because toenail fungus is deemed a cosmetic issue, not a serious health matter. Treatment is elective and based more on the appearance of the feet than an actual health threat. The cosmetic side of nail fungus is perturbing to those who have it.

Does a podiatrist treat toenail fungus?

It’s a pain free, non-invasive treatment without any worrying side effects, and can either be performed by a podiatrist in a clinic or — thanks to new technology- – in the comfort of your own home. And it kills toenail fungus within a matter of minutes.

How much does laser nail removal cost?

The cost varies depending on the number of nails involved and severity of the infection, with the national average cost for laser treatment varying from anywhere between $500 to $1200, which won’t be covered by medical insurance as it is considered a cosmetic treatment.

Can fungus grow under toenails?

Once it has taken hold, the fungus can quickly spread and grow underneath the toenail itself, causing pain and swelling around the nail, and often causing the nail to lift and break off completely. Up until recently, treatment for toenail fungus has come in the form of topical treatments or tablets, but neither treatment is sure to be effective.

Is Happy Toes effective against fungus?

Your toes will be happy but your toenail fungus sure won’t thanks to the Happy Toes Nail Fungus Treatment Laser Device that is effective against 99.9% of different types of toenail fungus.

Does Happy Toes treat nail fungus?

Happy Toes Nail Fungus Treatment Laser Device. Your toes will be happy but your toenail fungus sure won’t thanks to the Happy Toes Nail Fungus Treatment Laser Device that is effective against 99.9% of different types of toenail fungus.

How long does it take for a toenail to grow out after laser treatment?

The damaged toenail needs to grow out and be replaced by a healthy, fungus free nail, which can take anything from 3 months to a year depending on how much of the toenail was affected.

How long does it take for a nail regrowth device to work?

Use the device for just 7 minutes each day to start seeing results in as quickly as 4 weeks.

What is the treatment for toenail fungus?

What do you know about laser treatment for toenail fungus? A. Two lasers using different types of laser energy have attracted attention as treatments for fungal infection of the toenails, a condition called onychomycosis (pronounced oh-nee-koh-my-KOH-sis), which can also affect the fingernails.

Can lasers cause fungal infection?

A. Two lasers using different types of laser energy have attracted attention as treatments for fungal infection of the toenails, a condition called onychomycosis (pronounced oh-nee-koh-my-KOH-sis), which can also affect the fingernails.

Can lasers kill fungus?

The theory is that a precisely directed laser can eliminate the fungus without harming the surrounding nail tissue.

Can lasers kill fungal organisms?

Although there is some laboratory evidence that lasers can squelch fungal organisms, clinical studies in humans thus far are limited.

What is laser treatment for toenail fungus?

Laser therapy is a treatment for toenail fungus infection (onychomycosis), a hard-to-treat infection that changes the appearance and texture of the nail. There are several types of laser treatment options, including those that use light and those that use carbon dioxide (CO2).

Can toenail fungus be treated with oral medications?

When you're considering treatment options for toenail fungus infection, there are a number of factors to keep in mind. Oral medications can cause side effects, and topical medications require consistent treatment, often with little improvement to show for it.

Does laser sterilization kill fungus?

2 . When the laser is targeted to the area of infection, the heat that's produced inhibits the growth of the fungus and destroys it.

How long does it take for a laser to work on a nail?

Fungal infections of the nails usually require several laser treatment sessions before they completely resolve. It may take between six and 18 months of consistent treatments for laser therapy to be effective.

How long does it take for laser therapy to work?

It may take between six and 18 months of consistent treatments for laser therapy to be effective. While these treatments may cause side effects such as pain and/or bleeding of the surrounding area, they are considered safe. 1 .

Can you cure a fungal infection with one treatment?

The fungal growth is inhibited and some of the fungal microorganisms are destroyed, but since the infection can partially survive the treatment, it's unlikely that you will be completely cured with just one session.

What lasers are used for onychomycosis?

Several types of laser devices have been cleared by the FDA for the treatment of onychomycosis, including PinPointe Footlaser, GenesisPlus, and Noveon. According to the criteria for approval, these devices may produce a "temporary increase in clear nails in patients with onychomycosis." 3 

Can laser nail removal help toenail fungus?

Facing debridement or complete removal of the nail is a horrifying thought for those who suffer from toenail fungus. Laser methods keep the nail intact, meaning the nail will look better after this treatment than some other treatments.

Is laser toenail fungus treatment experimental?

It’s Still Considered Experimental Treatment. Because few studies have been done on the efficacy of laser toenail fungus treatment and none have been done on the long-term effects of the method, it is still viewed as experimental treatment with questionable success results.

Can toenail fungus be treated with topical cream?

Like a weed that’s out of control, toenail fungus can take hold of your feet and make you feel as if it will never let go. Because nails are impenetrable, even aggressive treatment with traditional anti-fungal pills and topical creams may not stop the condition (also called onychomycosis or tinea unguium) from wreaking havoc on both your feet ...

How to treat nail fungus?

The newest method to tackle nail fungus is laser light treatment . Essentially, a laser beam penetrates the thickened nail and destroys the affected tissue — without damaging the healthy tissue that surrounds it.

How much does it cost to remove fungus from toenails?

One laser toenail fungus removal session could cost anywhere from $600 to $1500 — and it’s a process generally not covered by health insurance. Before deciding whether or not to try laser toenail fungus removal, be sure to consult with a podiatrist or a dermatologist about your condition.

When was laser toenail removal approved?

Though laser toenail removal is a fairly new removal method, having been introduced into the medical community in the mid-2000s and approved by the FDA in 2010, the initial studies showed that it had a clinical response rate of 87%.

Is laser nail removal painless?

It Is Quick, Painless and Requires No Drugs or Anesthesia. Unlike toenail removal surgeries, laser nail fungus removal is a relatively fast procedure that requires no drugs or anesthesia. It’s also said to be painless. © Image Source/Corbis. RELATED ARTICLES:

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