Section 471-19-004 - SERVICE REQUIREMENTS004.01 GENERAL REQUIREMENTS.004.01(A)MEDICAL NECESSITY. Nebraska Medicaid incorporates the definition of medical necessity from 471 NAC 1. Services and supplies that do not meet the 471 NAC) 1 definition of medical necessity are not covered.004.01(B)SERVICES PROVIDED FOR RECIPIENTS ENROLLED IN THE NEBRASKA I MEDICAID MANAGED CARE PROGRAM. See 471 NAC 1.004.01(C)EARLY AND PERIODIC, SCREENING, DIAGNOSIS, AND TREATMENT (EPSDT) SERVICES. See 471 NAC 33.004.02COVERED SERVICES. Nebraska Medicaid covers medically necessary podiatry services within the scope of the podiatrist's licensure and within program guidelines. 004.02(A)ROUTINE FOOTCARE, Routine foot care includes:(1) Cutting or removal of corns or calluses:(3) Other hygienic and preventive maintenance care or debridement: and(4) Any services performed in the absence of localized illness, injury, or symptoms involving the foot.004.02(A)(i)FREQUENCY LIMITATIONS. Coverage of routine foot care is limited to: (a) One treatment every 90 days for non-ambulatory recipients: or(b) One treatment every 30 days for ambulatory recipients.004.02(A)(ii)EVALUATION AND MANAGEMENT (E&M) SERVICES. (E&M) services are not covered in addition to routine foot care on the same date of service, except: (a) New patient visits: or(b) When another separately identifiable service or procedure provided on the same date is documented in the medical record. 004.02(B)SURGERY. Surgical procedures performed by podiatrists must be in accordance with the provisions of Neb. Rev. Stat 38-3011. 004.02(B)(i)SITE OF SERVICE LIMITATIONS. Nebraska Medicaid accepts Medicare's determination of surgical procedures that are primarily performed in office settings.004.02(B)(ii)STERILE SURGICAL TRAYS. Nebraska Medicaid covers one sterile surgical tray for each surgical procedure the podiatrist performs on an individual, in their office.004.02(B)(iii)ASSISTANT SURGERY. Nebraska Medicaid covers an assistant surgeon only for surgical procedures that are identified as warranting an assistant surgeon.004.02(C)SUPPORTIVE DEVICES OF THE FEET. Nebraska Medicaid covers orthopedic footwear, shoe corrections, orthotic devices and similar supportive devices for the feet if medically necessary for the recipient's condition, in addition to coverage as outlined herein, please see 471 NAC 7.004.02(D)CLINICAL LABORATORY SERVICES. Nebraska Medicaid covers clinical laboratory services that are:(ii) Provided in a podiatrist's, or group of podiatrists', private office; and(iii) Provided or supervised by the podiatrist(s).004.02(E)INJECTIONS. Nebraska Medicaid covers intramuscular and subcutaneous injections at the cost of the medication plus an injection fee.004.02(F)SUPPLIES. Nebraska Medicaid may cover medically necessary supplies that are used during the course of treatment and require application by the podiatrist. Routine supplies, and supplies that are considered incidental to the professional service are not covered.471 Neb. Admin. Code, ch. 19, § 004
Amended effective 12/5/2015.Amended effective 12/26/2021