Md. Code Regs. 10.09.15.05

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.15.05 - Limitations

A. The Program does not cover the following under this chapter:

(1) Services which are not medically necessary;

(2) Investigational or experimental drugs or procedures;

(3) Services prohibited by the Maryland Podiatry Act or the State Board of Podiatric Medical Examiners;

(4) Services denied by Medicare as not medically justified;

(5) Drugs and supplies which are acquired by the podiatrist at no cost;

(6) Injections and visits solely for the administration of injections, unless medical necessity and the patient's inability to take oral medications are documented in the patient's medical record;

(7) More than one visit per day unless adequately documented in the patient's medical record as an emergency;

(8) Visits by or to the podiatrist solely for the purpose of the following:

(a) Prescription or drug pick-up,

(b) Collection of specimens for laboratory procedures, except by venipuncture, capillary or arterial puncture; and

(c) Interpretation of laboratory tests or panels;

(9) Physical therapy;

(10) Orthotics and inlays of any type and related services;

(11) Disposable medical supplies;

(12) Administration of anesthesia as a separate charge;

(13) Personal hygiene care;

(14) Routine care, except visits for participants who are diabetic or who have a vascular disease affecting the lower extremities;

(15) Non-surgical hospital visits;

(16) Laboratory or X-ray services not performed by the provider or under the direct supervision of the provider; and

(17) Podiatric inpatient hospital services rendered during an admission denied by the utilization control agent or during a period that is in excess of the length of stay authorized by the utilization control agent.

B. Routine podiatric care is limited to one visit every 60 days for participants who have diabetes or peripheral vascular diseases that affect the lower extremities when rendered in the podiatrist's office, the participant's home, or a nursing facility.

C. A licensed podiatrist shall perform in a licensed hospital or ambulatory surgical center, subject to the provisions of Health-General Article, §19-351, Annotated Code of Maryland, all surgical procedures of the ankle below the level of the dermis, arthrodeses of two or more tarsal bones, and complete tarsal osteotomies. A licensed podiatrist who performs these procedures in an ambulatory surgical center shall:

(1) Have current privileges at a licensed hospital for the same procedures; and

(2) Meet the requirements of the ambulatory surgical center.

Md. Code Regs. 10.09.15.05

Regulation .05A amended effective February 15, 1982 (9:3 Md. R. 221)
Regulation .05C amended effective January 2, 2006 (32:26 Md. R. 1997); amended effective 45:14 Md. R. 696, eff. 7/16/2018