Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-7 - Podiatric Services
Section 5160-7-01 - Podiatry services
Universal Citation: OH Admin Code 5160-7-01
Current through all regulations passed and filed through September 16, 2024
(A) For the purpose of this rule the following definitions apply.
(1)
"Doctor of
podiatric medicine" (or "podiatric physician" or "podiatrist") is as described
in section 4731.51 of the Revised
Code.
(a)
Doctors of podiatric medicine are deemed to be physicians
only in respect to functions they are legally authorized to perform in
accordance with section
4731.51 of the Revised Code and
rule 4731-20-02 of the Administrative
Code.
(b)
For purposes of medicaid coverage and payment, an
intern or resident of podiatric medicine is not a podiatric physician. This
exclusion applies even if an intern or resident is authorized to practice as a
podiatric physician under the laws of the state in which services are performed
or a resident holds a staff or faculty appointment or is designated as a
fellow. For purposes of medicaid coverage and payment, an intern or resident of
podiatric medicine is not a podiatric physician.
(2)
"Podiatric group
practice" is a professional association organized under Chapter 1785. of the
Revised Code for the purpose of providing podiatric medicine
services.
(B) Coverage.
(1)
Services and procedures performed by a doctor of
podiatric medicine that are within the scope of practice of a podiatric
physician are considered to be physician services. They are subject to and are
covered in accordance with applicable medicaid rules in the Administrative Code
concerning physician services.
(2)
The services of
interns and residents of podiatric medicine rendered in a hospital setting are
covered as hospital services in accordance with Chapter 5160-2 of the
Administrative Code.
(3)
Podiatric medicine services provided by a physician
assistant are covered in accordance with rule
5160-4-03 of the Administrative
Code.
(4)
Podiatric medicine services provided by an advanced
practice registered nurse are covered in accordance with rule
5160-4-04 of the Administrative
Code.
(C) Constraints and limitations.
(1)
A "by report"
podiatric medicine service or procedure is covered in accordance with rule
5160-1-60.4 of the
Administrative Code.
(2)
Payment for evaluation and management (E&M)
services is limited to the following services:
(a)
Professional
services of the following types necessitating straightforward medical
decision-making or medical decision-making of low, moderate, or high
complexity:
(i)
Office or other outpatient visit;
(ii)
Hospital
inpatient services;
(iii)
Office or outpatient consultations;
(iv)
Inpatient
consultations;
(v)
Nursing facility services;
(vi)
Domiciliary,
rest home (e.g., boarding home), or custodial care services;
(vii)
Home services;
and
(b)
Hospital discharge services, thirty minutes or
less.
(3)
Payment for the debridement of nails is limited to one
treatment per sixty-day period.
(4)
Payment may be
made for the following services only if an individual has a localized
infection; is under the care of another healthcare practitioner for a metabolic
disease such as diabetes mellitus or another condition that may result in
circulatory impairment or desensitization in the legs or feet; or has a
systemic metabolic, neurologic, or peripheral vascular disease or condition
that may require scrupulous foot care by another healthcare practitioner:
(a)
Examinations and
diagnostic services associated with routine foot care performed in the absence
of a localized illness, symptoms, or injury;
(b)
Cutting or
removal of corns and calluses;
(c)
Trimming,
cutting, or clipping of nails not associated with nail surgery;
(d)
Foot care
provided for hygienic purposes; and
(e)
Treatment of
uncomplicated, chronic foot conditions such as flat feet or a subluxated
structure in the foot.
(5)
Payment may be
made for the treatment of mycotic toenails only if the healthcare practitioner
attending the mycotic condition furnishes the podiatric physician with clinical
evidence of at least one of the following conditions:
(a)
Onychomycosis of
the toenail; and
(b)
Mycosis or dystrophy of the toenail causing secondary
infection or pain that has resulted or could result in marked limitation of
ambulation.
(6)
Payment may be made for the following radiology
services as podiatric medicine services only if the indicated criterion is
fully documented:
(a)
A bilateral radiograph for a unilateral condition or
surgical procedure when it is medically indicated;
(b)
Radiographs in
excess of three views when trauma or infection is present;
(c)
A radiograph of
soft tissue when infection is present; and
(d)
A postoperative
radiograph when bone involvement necessitated the surgical procedure or
postoperative infection is suspected.
(7)
Payment for
physical medicine services is limited to acute conditions. When a disease or
condition has reached a chronic stage, payment may be made only for services or
procedures performed during periods of acute exacerbation.
(8)
Payment may be
made for a range-of-motion study separately from an examination of the foot
only if the need is substantiated by a complete report.
(9)
Payment may be
made for vaccinations administered within a podiatrist's normal scope of
practice in accordance with state law and rule
5160-4-12 of the Administrative
Code.
(10)
The following services are not covered as podiatric
medicine services:
(a)
Vitamin B-12 injection for strengthening tendons,
ligaments, or other components of the foot;
(b)
Medical supplies
and equipment (e.g., tape, dressing, surgical trays) that are provided during a
podiatric medicine visit and are not intended for take-home use;
and
(c)
The use of radiography or radioactive material for
therapeutic purposes.
Replaces: 5160-7-01, 5160-7-02, 5169-7-03, 5160-7-04
Disclaimer: These regulations may not be the most recent version. Ohio 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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