Current through Register Vol. 47, No. 5, March 10, 2024
8.810.1
Definitions
Foot hygiene means the cleaning and soaking of the feet to
maintain a clean condition.
Mid-calf means 50% of the total distance between the talus
and tibial plateau.
Podiatry includes the suggesting, recommending, prescribing,
or administering of any podiatric form of treatment, operation, or healing for
the intended palliation, relief, or cure of any disease, ailment, injury,
condition, or defect of the human toe, foot, ankle, tendons that insert into
the foot, and soft tissue wounds below the mid-calf, including complications
thereof consistent with such scope of practice. It may include partial
amputation of the foot, but it does not involve the complete amputation, or
disarticulation between the talus and the tibia, or the administration of an
anesthetic, other than a local anesthetic.
Routine Foot Care means the cutting or removal of corns and
calluses; trimming, cutting, or debriding of nails; and other hygienic care due
to a physical or clinical finding that is consistent with a metabolic,
neurological, or peripheral vascular disease diagnosis and indicative of
significant peripheral involvement.
Soft tissue wound means a lesion to the musculoskeletal
junction that includes dermal and sub-dermal tissue that does not involve bone
removal or repair or muscle transfer.
8.810.2
CLIENT ELIGIBILITY
8.810.2.A. All Colorado Medicaid-enrolled
Clients are eligible for Podiatry services.
8.810.3
PROVIDER ELIGIBILITY
8.810.3.A. All Colorado Providers enrolled in
Medicaid are eligible to perform Podiatry services when it is within the scope
of the Provider's practice.
8.810.4
COVERED SERVICES
8.810.4.A. Colorado Medicaid covers the
examination, diagnosis, and treatment of the foot and ankle up to the mid-calf
when medically necessary as described in Section 8.076.1.8.
8.810.4.B. Providers may provide avulsions
involving the removal of the entire nail or a portion thereof without
destruction of the nail matrix. Documentation substantiating services received
more frequently than once every four months shall be detailed in the Client's
medical record.
8.810.4.C.
LIMITATIONS
1. Routine Foot Care services are
covered only when:
a. The Client or caregiver
is not capable of performing routine foot care without risk of injury; and
b. The procedure does not duplicate
another Provider's procedure during a 60 day period, which starts from the date
of service of the first procedure; and
c. One of the following:
i) The services are an integral part of
otherwise covered services; or,
ii)
Documentation illustrates the presence of metabolic, neurological, or
peripheral vascular disease or provides evidence of specific active
complications resulting from prior insults due to systemic conditions;
or,
iii) There is evidence of
pathologic nail infection that, in the absence of a systemic condition, results
in intolerable pain or secondary infection.
2. Coverage for the debridement and reduction
of nails, corns, and calluses is limited to once every 60 days. A Provider may
provide both debridement and reduction of nails at the same visit. Once a
Client has received either a debridement or reduction of nails or both, neither
service is available for 60 days after the treatment.
3. When a Client requires excision procedures
to be performed more than once, the medical record shall reflect the reason for
persistent or recurrent infections and a plan for future preventative measures
being taken.
4. Services that occur
in a long term care (LTC) facility shall only be covered when:
a. The Client residing in the LTC facility,
an RN, or LPN employed by the facility, the Client's family, guardian, or
attending physician requests the Service;
b. The LTC facility arranges for the
podiatric services; and,
c. The
request and arrangement is documented in the medical record.
5. Excision of nail and matrix for
permanent removal shall only be covered once per toe.
6. For established Clients, an evaluation and
management visit service shall not be covered if the evaluation and management
visit occurs on the same day as a debridement or reduction of nails, corns, and
calluses, unless there is another separately identifiable service or procedure
documented in the medical record.
8.810.5
NON-COVERED SERVICES
8.810.5.A. The following Podiatry services
are not covered by Colorado Medicaid:
1.
Surgical assistant services (differing from assisting surgeons).
2. Local anesthetics that are billed as a
separate procedure.
3. Operating
room facility charges for in-office procedures.
4. Treatment of subluxation of the
foot.
5. Treatment of flat
feet.
6. Routine supplies provided
in the office.
