Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 19 - PODIATRY SERVICES
Section 471-19-005 - BILLING AND PAYMENT FOR SERVICES
Universal Citation: 471 NE Admin Rules and Regs ch 19 ยง 005
Current through September 17, 2024
005.01 BILLING.
005.01(A)
GENERAL BILLING REQUIREMENTS. Providers must comply
with all applicable billing requirements codified in 471 NAC 3. In the event
that billing requirements in 471 NAC 3 conflict with billing requirements
outlined in 471 NAC 19, the billing requirements in 471 NAC 19 will
govern.
005.01(B)
SPECIFIC BILLING REQUIREMENTS.
005.01(B)(i)
BILLING
INSTRUCTIONS. Providers must bill Nebraska Medicaid using the
appropriate claim form or electronic format.
005.02 PAYMENT.
005.02(A)
GENERAL PAYMENT
REQUIREMENTS. The department will reimburse the provider for
services rendered in accordance with the applicable payment regulations
codified in 471 NAC 3. in the event that payment regulations in 471 NAC 3
conflict with payment regulations outlined in 471 NAC 19, the payment
regulations in 471 NAC 19 will govern.
005.02(B)
SPECIFIC PAYMENT
REQUIREMENTS.
005.02(B)(i)
REIMBURSEMENT. Nebraska Medicaid pays for covered
podiatry services in an amount equal to the lesser of:
(1) The provider's submitted charge;
and
(2) The allowable amount for
that procedure code in the Nebraska Medicaid Practitioner Fee Schedule in
effect for that date of service.
005.02(B)(ii)
MEDICARE AND
NEBRASKA MEDICAID CROSSOVER CLAIMS. For information on the payment
of Medicare and Nebraska Medicaid crossover claims, see 471 NAC 3.
005.02(B)(iii)
COPAYMENT. For Nebraska Medicaid copayment requirements, see 471
NAC 3.
005.02(B)(iv)
PAYMENT FOR SURGERY. Payment for surgeries is as
follows:
(1) Surgical procedures are arranged
in descending order according to the Department's allowable charges. The major
procedure is paid at 100 percent of the allowable charge; and
(2) Subsequent procedures are paid at 50
percent of the allowable charge.
(3) Except for the initial office visit,
payment for major surgical procedures includes office visits on the day of
surgery and 14 days of post-operative care. The department follows the surgery
guidelines in the American Medical Association's Current Procedural Terminology
(CPT).
(4) Payment for surgical
procedures that are primarily performed in office settings is reduced by 12
percent when performed in hospital outpatient settings, including emergency
departments.
005.02(B)(v)
STERILE SURGICAL
TRAYS. Payment for a sterile surgical tray includes routine or
special surgical instruments, office operating room cost, sutures, supplies,
items used to prepare a sterile field for the surgical procedure, and the
sterilization and maintenance of these items.
005.02(B)(vi)
SUPPORTIVE DEVICES
FOR THE FEET. Payment for custom orthotic devices which require
impression casting by the podiatrist includes:
(1) Fitting;
(2) Cost of parts and labor;
(3) Repairs due to normal wear and tear
within 90 days of the date dispensed; and
(4) Adjustments made when fitting and for 90
days from the date dispensed.
(a) Adjustments
necessitated by changes in the recipient's medical condition, or the
recipient's functional abilities, are reimbursed separately.
005.02(B)(vii)
CLINICAL LABORATORY SERVICES. Payment for specimens
obtained in the podiatrist's office and sent to an independent clinical lab or
hospital for processing must be claimed by the facility performing the tests.
The Department does not reimburse the podiatrist for handling specimens or
processing or interpreting tests performed outside the podiatrist's
office.
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
