Section 140.425 Podiatry Services

Section 140

Section 140.425  Podiatry

Services

a)         Payment

for podiatry services shall be made only to licensed podiatrists.

b)         Effective July 1, 2012 through September 30, 2014, payment

shall be made for those podiatric services provided to recipients under the age

of 21 or recipients age 21 and over who have been diagnosed with diabetes as

defined in the International Classification of Diseases, 9

th

Revision.

c)         Payment

shall be made for the following:

1)         Effective

July 1, 2012 through September 30, 2014, payment shall be made for those

podiatric services that are:

A)        Limited to recipients under the age of 21 or recipients age 21

and over who have been diagnosed with diabetes as defined in the International

Classification of Diseases.

B)        Essential for the diagnosis and treatment of conditions of the

feet and ankles.

C)        Listed in the Current Procedural Terminology (CPT) fourth

edition published by the American Medical Association or Healthcare Common

Procedure Coding System (HCPCS) Level II, for podiatric office visits,

diagnostic radiology, pathology, or orthomechanical procedures included in the

Department's schedule of podiatric services as itemized in Table F.

D)        Performed by the podiatrist or under the direct supervision of

the podiatrist.

E)        Routine

foot care services (trimming of nails, treatment of calluses, corns, and

similar services) when a participant is under active treatment for diabetes

mellitus.

2)         Effective

October 1, 2014, payment shall be made for those podiatric services that are:

A)        Essential

for the diagnosis and treatment of conditions of the feet and ankles.

B)        Listed

in the CPT or HCPCS Level II for podiatric office visits, diagnostic radiology,

pathology, or orthomechanical procedures included in the Department's schedule

of podiatric services as itemized in Table F.

C)        Performed

by the podiatrist or under the direct supervision of the podiatrist

Essential

for the diagnosis and treatment of conditions of the feet and ankles.

B)        Listed

in the CPT or HCPCS Level II for podiatric office visits, diagnostic radiology,

pathology, or orthomechanical procedures included in the Department's schedule

of podiatric services as itemized in Table F.

C)        Performed

by the podiatrist or under the direct supervision of the podiatrist.

D)        Routine

foot care services (trimming of nails, treatment of calluses, corns, and

similar services) when a participant is under active treatment for diabetes

mellitus or has a systemic condition that has resulted in severe circulatory

impairment or an area of desensitization in the legs or feet and routine type

foot care is required.

d)         Payment shall not be made for the following services:

1)         Making a referral, obtaining a specimen, handling a specimen

for analysis, or ordering a laboratory test;

2)         Visits and services provided to recipients eligible for

Medicare benefits if the services are determined not medically necessary by

Medicare;

3)         Services provided to recipients in group care facilities by a

podiatrist who derives direct or indirect profit from total or partial

ownership of the facility;

4)         Routine foot care, except as described in subsections (c)(1)(E)

and (c)(2)(D);

5)         Screening for foot problems;

6)         Provider transportation costs;

7)         X-rays, and laboratory procedures performed at a location

other than the podiatrist's own office;

8)         X-rays, laboratory work or similar services not specifically

required by the condition for which the recipient is being treated;

9)         Routine

post-operative visits.