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Elizabeth M. Whitehorn, Director

Provider Notice issued 07/23/12

Limitations on Podiatric Services

To:​ ​Participating Podiatrists
​Date: ​July 23, 2012
​Re: Limitations on Podiatric Services​

The purpose of this notice is to advise providers of limitations for podiatry services provided to participants 21 years of age and over. This notice supersedes the informational notice issued on June 30, 2012.

Effective with dates of service July 1, 2012 and after, coverage for podiatric services provided to participants 21 years of age and older will be limited to services provided to participants with diabetes for a diabetes-related condition of the foot/ankle.

The specific payable procedure codes and their limitations will be listed on the July 1, 2012 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 primary diagnosis of diabetes (ICD-9-CM 250.xx range) and a secondary diagnosis code reflecting the condition that resulted from the diabetes, such as a diabetic foot ulcer. 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