Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
| Contract | Contractor | Type | States |
|---|---|---|---|
| 09102 | First Coast Service Options, Inc. | A and B MAC | FL |
| 09202 | First Coast Service Options, Inc. | A and B MAC | PR |
| 09302 | First Coast Service Options, Inc. | A and B MAC | VI |
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A57672 (Billing and Coding: Nail Debridement) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A57672: Billing and Coding: Nail Debridement (Billing and Coding)
- Covered ICD-10-CM codes
- 26
- 1 group
- Non-covered ICD-10-CM codes
- 1
- Procedure codes listed
- 2
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| B35.1 | — |
| B37.2 | — |
| B42.1 | — |
| B42.7 | — |
| B42.89 | — |
| B42.9 | — |
| B43.0 | — |
| B43.8 | — |
| B43.9 | — |
| B44.7 | — |
| B44.89 | — |
| B44.9 | — |
| B45.2 | — |
| B45.7 | — |
| B45.8 | — |
| B45.9 | — |
| B46.3 | — |
| B46.4 | — |
| B46.5 | — |
| B46.8 | — |
| B46.9 | — |
| B47.0 | — |
| B48.1 | — |
| B48.2 | — |
Procedure codes: 11720, 11721.
Coverage indications, limitations and medical necessity
Please refer to CMS IOM Publication 100-02, Medicare Benefit Policy Manual , Chapter 15, Section 290 Foot Care for indications and limitations in coverage for treatment of mycotic nails.
Covered Indications
Medicare will consider the treatment of fungal (mycotic) infection of the nails a covered service when the medical record substantiates:
• Clinical evidence of mycosis of the nail, by generally accepted clinical findings such as discoloration, onycholysis, subungual debris, thickening, or secondary skin infection;
In addition one of the following must be documented for mycotic toenails:
• the ambulatory patient has marked limitation of ambulation, pain, or secondary infection resulting from the thickening and dystrophy of the infected toenail plate(s); or
• the non-ambulatory patient suffers from pain or secondary infection resulting from the thickening and dystrophy of the infected toenail plate(s).
Appropriate anti-fungal treatment is necessary to qualify nail debridement as a medically necessary and reimbursable service unless contraindicated. If an anti-fungal treatment is not used, the contraindication must be documented in the medical record.
Patients need not have an underlying systemic condition to be covered for mycotic nail care.
Limitations
As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual , Chapter 13, Section 13.5.4, an item or service may be covered by a contractor LCD if it is reasonable and necessary under the Social Security Act Section 1862 (a)(1)(A). Contractors shall determine and describe the circumstances under which the item or service is considered reasonable and necessary.
Summary of evidence (opening)
N/A
the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2019-11-28
- Last reviewed by the contractor
- 2018-10-17
- MCD version
- 12
- Derived from
- L29232
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the First Coast Service Options, Inc. hub lists every other active policy from the same contractor.
Frequently asked questions
What does LCD L33922 cover?
Please refer to CMS IOM Publication 100-02, Medicare Benefit Policy Manual , Chapter 15, Section 290 Foot Care for indications and limitations in coverage for treatment of mycotic nails. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L33922 apply to?
First Coast Service Options, Inc. applies it to Medicare claims in FL, PR, VI. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L33922?
The companion billing and coding article A57672 lists 26 ICD-10-CM codes in 1 group that support medical necessity and 1 that do not; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L33922?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.