10 Colo. Code Regs. § 2505-10-8.810

Current through Register Vol. 47, No. 24, December 25, 2024

Section 10 CCR 2505-10-8.810 - PODIATRY SERVICES

8.810.1Definitions

Foot hygiene means the cleaning and soaking of the feet to maintain a clean condition.

Mid-calf means 50% of the total distance between the talus and tibial plateau.

Podiatry includes the suggesting, recommending, prescribing, or administering of any podiatric form of treatment, operation, or healing for the intended palliation, relief, or cure of any disease, ailment, injury, condition, or defect of the human toe, foot, ankle, tendons that insert into the foot, and soft tissue wounds below the mid-calf, including complications thereof consistent with such scope of practice. It may include partial amputation of the foot, but it does not involve the complete amputation, or disarticulation between the talus and the tibia, or the administration of an anesthetic, other than a local anesthetic.

Routine Foot Care means the cutting or removal of corns and calluses; trimming, cutting, or debriding of nails; and other hygienic care due to a physical or clinical finding that is consistent with a metabolic, neurological, or peripheral vascular disease diagnosis and indicative of significant peripheral involvement.

Soft tissue wound means a lesion to the musculoskeletal junction that includes dermal and sub-dermal tissue that does not involve bone removal or repair or muscle transfer.

8.810.2CLIENT ELIGIBILITY

8.810.2.A. All Colorado Medicaid-enrolled Clients are eligible for Podiatry services.

8.810.3PROVIDER ELIGIBILITY

8.810.3.A. All Colorado Providers enrolled in Medicaid are eligible to perform Podiatry services when it is within the scope of the Provider's practice.

8.810.4COVERED SERVICES

8.810.4.A. Colorado Medicaid covers the examination, diagnosis, and treatment of the foot and ankle up to the mid-calf when medically necessary as described in Section 8.076.1.8.

8.810.4.B. Providers may provide avulsions involving the removal of the entire nail or a portion thereof without destruction of the nail matrix. Documentation substantiating services received more frequently than once every four months shall be detailed in the Client's medical record.

8.810.4.C. LIMITATIONS

1. Routine Foot Care services are covered only when:

a. The Client or caregiver is not capable of performing routine foot care without risk of injury; and

b. The procedure does not duplicate another Provider's procedure during a 60 day period, which starts from the date of service of the first procedure; and

c. One of the following:

i) The services are an integral part of otherwise covered services; or,

ii) Documentation illustrates the presence of metabolic, neurological, or peripheral vascular disease or provides evidence of specific active complications resulting from prior insults due to systemic conditions; or,

iii) There is evidence of pathologic nail infection that, in the absence of a systemic condition, results in intolerable pain or secondary infection.

2. Coverage for the debridement and reduction of nails, corns, and calluses is limited to once every 60 days. A Provider may provide both debridement and reduction of nails at the same visit. Once a Client has received either a debridement or reduction of nails or both, neither service is available for 60 days after the treatment.

3. When a Client requires excision procedures to be performed more than once, the medical record shall reflect the reason for persistent or recurrent infections and a plan for future preventative measures being taken.

4. Services that occur in a long term care (LTC) facility shall only be covered when:

a. The Client residing in the LTC facility, an RN, or LPN employed by the facility, the Client's family, guardian, or attending physician requests the Service;

b. The LTC facility arranges for the podiatric services; and,

c. The request and arrangement is documented in the medical record.

5. Excision of nail and matrix for permanent removal shall only be covered once per toe.

6. For established Clients, an evaluation and management visit service shall not be covered if the evaluation and management visit occurs on the same day as a debridement or reduction of nails, corns, and calluses, unless there is another separately identifiable service or procedure documented in the medical record.

8.810.5NON-COVERED SERVICES

8.810.5.A. The following Podiatry services are not covered by Colorado Medicaid:

1. Surgical assistant services (differing from assisting surgeons).

2. Local anesthetics that are billed as a separate procedure.

3. Operating room facility charges for in-office procedures.

4. Treatment of subluxation of the foot.

5. Treatment of flat feet.

6. Routine supplies provided in the office.

10 CCR 2505-10-8.810