Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 19 - PODIATRY SERVICES
Section 471-19-004 - SERVICE REQUIREMENTS
Universal Citation: 471 NE Admin Rules and Regs ch 19 ยง 004
Current through March 20, 2024
004.01 GENERAL REQUIREMENTS.
004.01(A)
MEDICAL NECESSITY. Nebraska Medicaid incorporates the
definition of medical necessity from 471 NAC 1. Services and supplies that do
not meet the 471 NAC) 1 definition of medical necessity are not
covered.
004.01(B)
SERVICES PROVIDED FOR RECIPIENTS ENROLLED IN THE NEBRASKA I
MEDICAID MANAGED CARE PROGRAM. See 471 NAC 1.
004.01(C)
EARLY AND PERIODIC,
SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT) SERVICES. See 471 NAC
33.
004.02 COVERED SERVICES. Nebraska Medicaid covers medically necessary podiatry services within the scope of the podiatrist's licensure and within program guidelines.
004.02(A)
ROUTINE FOOTCARE, Routine foot care includes:
(1) Cutting or removal of corns or
calluses:
(2) Trimming of
nails;
(3) Other hygienic and
preventive maintenance care or debridement: and
(4) Any services performed in the absence of
localized illness, injury, or symptoms involving the foot.
004.02(A)(i)
FREQUENCY
LIMITATIONS. Coverage of routine foot care is limited to:
(a) One treatment every 90 days for
non-ambulatory recipients: or
(b)
One treatment every 30 days for ambulatory recipients.
004.02(A)(ii)
EVALUATION AND
MANAGEMENT (E&M) SERVICES. (E&M) services are not covered
in addition to routine foot care on the same date of service, except:
(a) New patient visits: or
(b) When another separately identifiable
service or procedure provided on the same date is documented in the medical
record.
004.02(B)
SURGERY.
Surgical procedures performed by podiatrists must be in accordance with the
provisions of Neb. Rev. Stat 38-3011.
004.02(B)(i)
SITE OF SERVICE
LIMITATIONS. Nebraska Medicaid accepts Medicare's determination of
surgical procedures that are primarily performed in office settings.
004.02(B)(ii)
STERILE SURGICAL
TRAYS. Nebraska Medicaid covers one sterile surgical tray for each
surgical procedure the podiatrist performs on an individual, in their
office.
004.02(B)(iii)
ASSISTANT SURGERY. Nebraska Medicaid covers an
assistant surgeon only for surgical procedures that are identified as
warranting an assistant surgeon.
004.02(C)
SUPPORTIVE DEVICES OF
THE FEET. Nebraska Medicaid covers orthopedic footwear, shoe
corrections, orthotic devices and similar supportive devices for the feet if
medically necessary for the recipient's condition, in addition to coverage as
outlined herein, please see 471 NAC 7.
004.02(D)
CLINICAL LABORATORY
SERVICES. Nebraska Medicaid covers clinical laboratory services
that are:
(i) Medically necessary;
(ii) Provided in a podiatrist's, or group of
podiatrists', private office; and
(iii) Provided or supervised by the
podiatrist(s).
004.02(E)
INJECTIONS. Nebraska Medicaid covers intramuscular and
subcutaneous injections at the cost of the medication plus an injection
fee.
004.02(F)
SUPPLIES. Nebraska Medicaid may cover medically
necessary supplies that are used during the course of treatment and require
application by the podiatrist. Routine supplies, and supplies that are
considered incidental to the professional service are not
covered.
Disclaimer: These regulations may not be the most recent version. Nebraska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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