Subpart
1.
Definitions.
The following terms used in this part shall have the meanings
given them.
A. "Foot hygiene" means
the care of the foot to maintain a clean condition.
B. "Podiatry service" means a service
provided by a podiatrist within the scope of practice defined in Minnesota
Statutes, chapter 153.
Subp.
2.
Payment for debridement or reduction of nails, corns, and
calluses.
Debridement or reduction of pathological toenails and of
infected or eczematized corns or calluses shall be a covered service. The
service shall be eligible for payment once every 60 days.
Subp. 3.
Limitation on payment for
debridement or reduction of nails, corns, and calluses.
Payment for debridement or reduction of nonpathological
toenails and of noninfected or noneczematized corns or calluses is limited to
the conditions in items A to C.
A. The
recipient has a diagnosis of diabetes mellitus, arteriosclerosis obliterans,
Buerger's disease (thromboangitis obliterans), chronic thrombophlebitis, or
peripheral neuropathies involving the feet. The service is eligible for payment
only once every 60 days unless the service is required more often to treat
ulcerations or abscesses complicated by diabetes or vascular insufficiency.
Payment for treatment of ulcerations or abscesses complicated by diabetes or
vascular insufficiency is limited to services that are medically
necessary.
B. The recipient who is
not a resident of a long-term care facility has a medical condition that
physically prevents him or her from reducing the nail, corn, or callus.
Examples of such a medical condition are blindness, arthritis, and malformed
feet.
C. A podiatry visit charge
must not be billed on the same date as the date of the service provided under
item A or B.
Subp. 4.
Limitation on payment for podiatry service provided to a resident of a
long-term care facility.
To be eligible for medical assistance payment, a podiatry
service provided to a recipient who resides in a long-term care facility must
result from a self-referral or a referral by a registered nurse or a licensed
practical nurse who is employed by the facility or the recipient's family,
guardian, or attending physician.
Subp.
5.
Payment limitation; more than one recipient on same day
in same long-term care facility.
When a podiatry service is provided to more than one
recipient who resides in the same long-term care facility by the same provider
on the same day, payment for the provider's visit to the first recipient shall
be according to part
9505.0445, item E, for the
procedure code for the visit. The provider's visit on the same day to other
recipients within the same long-term care facility must be billed with the
multiple visit code established by the department. This subpart shall not apply
to a provider's visit to provide an emergency service on the same day within
the same long-term care facility if the emergency service could not have been
scheduled consecutively with another recipient visit. If the provider visits
other recipients in the same facility on the same day after providing an
emergency service, the provider's visits must be billed with the multiple visit
code.
Subp. 6.
Excluded services.
The podiatry services in items A to I are not eligible for
payment under the medical assistance program:
A. stock orthopedic shoes; "stock orthopedic
shoes" means orthopedic shoes other than those built to a person's
specifications as prescribed by a podiatrist;
B. surgical assistants;
C. local anesthetics that are billed as a
separate procedure;
D. operating
room facility charges;
E. foot
hygiene;
F. use of skin creams to
maintain skin tone;
G. service not
covered under Medicare, or service denied by Medicare because it is not
medically necessary;
H. debridement
or reduction of the nails, corns, or calluses except as in subparts
2 to
4; and
I. if the recipient is a resident of a
long-term care facility, general foot care that can be reasonably performed by
nursing staff of long-term care facilities. An example of general foot care is
the reduction of toenails, corns, or calluses of a recipient who is not
diagnosed as having a medical condition listed in subpart
3.