New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 57 - PODIATRY SERVICES
Subchapter 2 - PROVISION OF SERVICES
Section 10:57-2.1 - Covered and non-covered services
Universal Citation: NJ Admin Code 10:57-2.1
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The following foot care services shall not be covered:
1. Flat-foot conditions:
i. Exceptions:
(1) Treatment which is an integral part of post-fracture or postoperative treatment plan;
(2) Supportive devices (for example, arch supports, specific additions to shoes and the like) which are prescribed to palliate pain and other symptoms associated with the condition.
ii. Treatment where the talo-crural joint is involved;
iii. Treatment where there may be attachment of a supportive device to a brace or bar.
2. Subluxations of the feet in which the normal relationship of the bones, tendons, ligaments and supporting muscles is disturbed and which, regardless of underlying etiology, require treatment by mechanical methods (for example, whirlpool, paraffin baths, casting, strapping, splinting, padding, shortwave or low voltage currents, physical therapy, exercise manipulation, massage, and the like):
i. Exceptions:
(1) Where treatment is an integral part of post-fracture or postoperative treatment plan;
(2) Where the talo-crural joint is involved;
(3) Where there may be attachment of a supportive device to a brace or bar.
3. Routine foot care, routine hygienic care:
i. Exceptions:
(1) Treatment of painful corns, calluses and warts;
(A) When treatments are in excess of one per month, the case must be referred for evaluation to the podiatry unit of the Division of Medical Assistance and Health Services, PO Box 712, Mail Code #15, Trenton, New Jersey 08625-0712.
(2) Treatment of the foot for Medicaid/NJ FamilyCare beneficiaries with metabolic, neurological, and peripheral diseases (for examples, diabetes mellitus, arteriosclerosis obliterans, Buerger's disease, chronic thrombo-phlebitis, peripheral neuropathies); and
(3) Treatment of fungal (mycotic) and other infections of the feet and toenails.
(b) The following guidelines limit the provision of (a)3 above.
1. The importance of preventive or hygienic care for patients with a systemic illness, such as peripheral vascular disease, diabetes, or with severe physical disability is recognized. These will be considered on an individual basis by the podiatry consultant.
2. If services ordinarily considered routine are performed at the same time as and as a necessary integral part of otherwise covered services, such as diagnosis and treatment of diabetic ulcers, wounds and infections, they are covered.
3. Fungal (mycotic) and other infections of the feet and toenails require professional services which are outside the scope of "routine foot services." Diagnostic and treatment services for foot infections are covered in the same manner as services performed for infections occurring elsewhere on the body, and the same type of coverage rules apply.
4. Treatment of plantar warts that are symptomatic and/or cause disability will be considered a covered service.
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