Library: Policy

317:30-5-261. Coverage by category

Revised 9-1-21

        Payment is made to podiatrists as set forth in this Section:

(1) Adults.  Payment is made for medically necessary surgical procedures, x-rays, and outpatient visits.  Procedures which are generally considered as preventative foot care, i.e. cutting or removal of corns, warts, callouses, or nails, are not covered unless the diagnoses on the claim, i.e. diabetes, multiple sclerosis, cerebral vascular accident, peripheral vascular disease establishes the medical necessity for the service.  The patient must be under the active care of a doctor of medicine or osteopathy who documents the condition.  All services must be medically appropriate and related to systemic disease for which foot care is viewed as preventative in nature.  Nursing home visits must be ordered by the attending physician.  The nursing home record must contain appropriate documentation that the visit was not performed for screening purposes.  A specific foot ailment, symptom or complaint must be documented.  In instances where the examination is performed in response to specific symptoms or complaints which suggests the need for care, the visit is compensable regardless of the resulting diagnosis.  All outpatient visits are subject to existing visit limitations.

(2) Children.  Coverage of podiatric services for children is the same as for adults.  Refer to OAC 317:30-3-57 (13) for additional coverage under the Early and Periodic Screening, Diagnosis and Treatment Program.

(3) Individuals eligible for Part B of Medicare.  Payment for podiatric services is made utilizing the Medicaid allowable for comparable services.