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Elizabeth M. Whitehorn, Director

Provider Notice issued 06/30/12

Limitations on Podiatric Services

​To: ​Participating Podiatrists
​Date: ​June 30, 2012
​Re: Limitations on Podiatric Services​

As a result of Public Act 097-0689 (pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, effective July 1, 2012, coverage for podiatric services to participants 21 years of age and over will be limited to specific diabetic foot care evaluation and management services as defined by HCPCS Level II National Codes.

  • G0245- Initial evaluation and management of diabetic patient with diabetic sensory neuropathy

  • G0246- Follow-up evaluation and management of diabetic patient with diabetic sensory neuropathy

  • G0247- Routine foot care of a diabetic patient with diabetic sensory neuropathy including local care of superficial wounds

The specific payable procedure codes and their limitations will be listed on the 07-01-12 Podiatric Fee Schedule that will be posted on the department’s Web site.

Effective with dates of service on or after July 1, 2012, claims submitted for participants 21 years of age and over must include a diagnosis of diabetes (ICD-9-CM 250.xx range). If the claim does not include a diabetic diagnosis, it will reject. Providers will receive the error code G51, Podiatric service inappropriate for diagnosis.

Coverage for podiatric services to participants under the age of 21 remains unchanged.

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs