TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.425 PODIATRY SERVICES
Section 140.425 Podiatry Services
a) Payment for podiatry services shall be made only to licensed podiatrists.
b) Effective July 1, 2012, payment shall be made for those podiatric services provided to recipients under the age of 21 or recipients age 21 and over who have been diagnosed with diabetes as defined in the International Classification of Diseases. The allowable diagnosis code ranges will be specified in the Handbook for Providers of Podiatric Services.
c) Effective July 1, 2012, payment shall be made for those podiatric services that are:
1) Limited to recipients under the age of 21 or recipients age 21 and over who have been diagnosed with diabetes as defined in the International Classification of Diseases.
2) Essential for the diagnosis and treatment of conditions of the feet.
3) Listed in the Current Procedural Terminology (CPT) for podiatric office visits, diagnostic radiology, pathology, or orthomechanical procedures included in the Department's schedule of podiatric services.
4) Performed by the podiatrist or under the direct supervision of the podiatrist.
5) Routine foot care services (trimming of nails, treatment of calluses, corns, and similar services) when a participant is under active treatment for diabetes mellitus.
d) Payment shall not be made for the following services:
1) Making a referral, obtaining a specimen, handling a specimen for analysis, or ordering a laboratory test;
2) Visits and services provided to recipients eligible for Medicare benefits if the services are determined not medically necessary by Medicare;
3) Services provided to recipients in group care facilities by a podiatrist who derives direct or indirect profit from total or partial ownership of the facility;
4) Routine foot care, except as described in subsection (c)(5);
5) Screening for foot problems;
6) Provider transportation costs;
7) X-rays, and laboratory procedures performed at a location other than the podiatrist's own office;
8) X-rays, laboratory work or similar services not specifically required by the condition for which the recipient is being treated;
9) Routine post-operative visits.
(Source: Amended at 37 Ill. Reg. 10282, effective June 27, 2013)