South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:07 - Podiatric services
Section 67:16:07:04 - Services not covered

Universal Citation: SD Admin Rules 67:16:07:04

Current through Register Vol. 51, page 43, September 23, 2024

The following podiatry services are not covered under the medical assistance program:

(1) Stock orthopedic shoes, unless covered under chapter 67:16:11 for children less than twenty-one years of age, or built into a leg brace;

(2) The treatment of flatfoot;

(3) Surgical or nonsurgical treatment of subluxations of the foot, undertaken for the sole purpose of correcting a subluxated structure in the foot as an isolated entity, but not including:

(a) Surgical correction of a subluxated foot structure that is an integral part of the treatment of a foot injury; or

(b) Surgical correction of a subluxated foot structure that is undertaken to improve the function of the foot or to alleviate an inducted or associated symptomatic condition;

(4) Routine foot care, unless infected or eczematized, or the individual has been diagnosed with metabolic, neurologic, or peripheral vascular disease:

(a) Cutting or removing corns or calluses;

(b) Trimming nails;

(c) Hygienic and preventive maintenance care;

(d) Using skin creams to maintain the skin tone of ambulatory and bedfast patients; and

(e) The provision of services in the absence of localized illness, injury, or symptoms involving the foot; and

(5) Treatment of a fungal (mycotic) infection of the toenail, unless there is clinical evidence of mycosis of the toenail and medical evidence documenting that:

(a) The patient has a marked limitation of ambulation requiring active treatment of the foot; or

(b) The patient is nonambulatory and has a condition that is likely to result in significant medical complication in the absence of treatment.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1(1)(2).

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