Section 140.425  Podiatry Services

a)         Payment for podiatry services shall be made only to licensed podiatrists.

b)         Payment shall be made for those podiatric services that are:

1)         Essential for the diagnosis and treatment of conditions of the feet.

2)         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.

3)         Performed by the podiatrist or under the direct supervision of the podiatrist.

4)         Routine foot care services (trimming of nails, treatment of calluses, corns, and similar services) when a participant is under active treatment for diabetes mellitus or has a systemic condition that has resulted in severe circulatory impairment or an area of desensitization in the legs or feet and a routine type of foot care is required.  These services may not be provided at less than 60 day intervals.

c)         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 (b)(4) of this Section,

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 33 Ill. Reg. 16573, effective November 16, 2009)