Provider Notice issued 08/31/12

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 July 23, 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. Covered routine foot care services will be payable once every 61 days.

The specific payable procedure codes and their limitations will be listed on the revised 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 primary diagnosis of diabetes (ICD-9-CM 250.xx range) and a secondary diagnosis code reflecting the condition being treated, such as bunions, hammertoes, diabetic foot ulcer, etc. If the claim does not include a diabetic diagnosis as primary, 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