Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 424.000 - Podiatrist Services
Section 424.411 - Office Visits
Current through Register 1531, September 27, 2024
The MassHealth agency pays for four types of office visits: initial, limited, extended, and follow-up. The fees vary depending on the type of visit.
(A) The MassHealth agency pays for one initial visit (the member's first visit to a podiatrist) per member. This visit must include an initial comprehensive history, results of laboratory tests or other findings, whether positive or negative, and identification of both podiatric and general medical problems through vascular, orthopedic, neurological, dermatological, and musculoskeletal examination. The fee for an initial visit includes necessary treatment for relief of symptoms.
(B) The MassHealth agency pays for one limited visit per member within a 30-day period. A limited visit must include an interval history and examination and treatment of the foot, which may include removal of excrescences; palliative and prophylactic onychial care; treatment of hypertrophied toenails; and electroburring when the record documents that the member has a localized illness, injury, or symptoms involving the foot, including diabetes or peripheral vascular disease.
(C) The MassHealth agency pays for one extended visit per member within a 30-day period. An extended visit must include the application of flexible adhesive casting, minor modification to shoes, or electric modality physiotherapy. An extended visit may also include the removal of excrescences, palliative and prophylactic onychial care, treatment of hypertrophied or ingrown nails (or both), and other comparable procedures.
(D) The MassHealth agency pays for one follow-up visit per member per week. A follow-up visit is a return visit for a specific diagnosis (such as warts or an ulcer) in which a brief procedure, such as a dressing change, debridement, or removal of sutures, is performed.
(E) Payment for the removal of an ulcerated keratosis is included in the fees for any type of visit and must not be billed for separately.
(F) The MassHealth agency pays for either an office visit or a treatment or surgical procedure for the same member on the same date of service but not both.
