Ill. Admin. Code tit. 89, § 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, 9th 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.
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.
Notes
Amended at 37 Ill. Reg. 10282, effective June 27, 2013
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