Haw. Code R. § 17-1737-80 - Podiatry services

(a) Podiatry services means services directed toward the treatment and care of feet ailments or disorders of the foot and ankle that are provided by a podiatrist or a physician, who is licensed to practice in the State of Hawaii.

(b) Podiatry services and appliances (orthoses, prostheses) shall include, but are not limited to, the treatment of conditions of the foot and ankle such as:

(1) Professional services, not involving surgery, provided in the office and clinic; professional services, not involving surgery, related to diabetic foot care in the outpatient and inpatient hospital, skilled nursing facility, and intermediate care facility under the following conditions:

(A) Podiatry services, not involving surgery, in a hospital (inpatient or outpatient), skilled nursing facility, and intermediate care facility shall be considered as adjuncts to general medical care and limited to diabetic foot care;

(B) In the case of a patient requiring inpatient hospital care, podiatry services shall be limited to diabetic foot care only, must be ordered by the attending physician as noted by the physician in the medical chart, and may be furnished after obtaining prior authorization from the department's medical consultant; and

(C) In the case of a patient requiring podiatry services in a skilled nursing or an intermediate care facility, podiatry services shall be limited to diabetic foot care only and must be ordered by the attending physician as noted by the physician in the medical chart;

(2) Surgical procedures are limited to those involving the ankle and below; surgical procedures performed in the office, clinic, and skilled nursing or intermediate care facility with costs greater than $100 require prior authorization from the department's medical consultant or agent. All surgical procedures performed in the outpatient hospital require prior authorization from the department's medical consultants;

(3) Diagnostic radiology procedures limited to the ankle and below;

(4) Foot appliances (orthoses, prostheses);

(5) Orthopedic shoes and casts; and

(6) Orthodigital prostheses and casts.

(c) Foot and ankle care related to the treatment of infection or injury is covered in the office or an outpatient clinic setting.

(d) Bunionectomies are covered only when the bunion is present with overlying skin ulceration or neuroma secondary to the bunion.

(e) The following services shall not be covered under the program:

(1) Routine foot care, including debridement not related to treatment of infection or injury, with the exception of diabetic foot care in the inpatient hospital or nursing facility setting. Routine foot care, as defined for this purpose, includes:

(A) The cutting or removal of corns or calluses;

(B) The trimming of nails (including mycotic nails); and

(C) Other hygienic and preventive maintenance care in the realm of self-care, such as cleaning and soaking the feet, the use of shin creams to maintain skin tone of both ambulatory and bedfast patients;

(2) Treatment of flat feet;

(3) Any services performed in the absence of localized illness, injury or symptoms involving the foot and ankle are not covered;

(4) Bunionectomies are not covered if the sole indications are pain and difficulty finding appropriate shoes; and

(5) Services performed in, but not limited to, the following settings:

(A) A home;

(B) A domiciliary care home;

(C) A residential drug treatment program;

(D) A mental health group home;

(E) A therapeutic home; or

(F) A foster home.

(f) All podiatry services to be provided to a hospital inpatient or recommended appliances of a nonemergency nature and costing more than $100 shall require prior authorization by the department's medical consultant or agent. Requests for services or appliances shall be submitted on the appropriate departmental form by the patient's attending physician.

Notes

Haw. Code R. § 17-1737-80

[Eff 08/01/94; am 01/29/96; am 10/26/01; am 05/05/05] (Auth: HRS § 346-14) (Imp: 42 C.F.R. §440.60)