S.D. Admin. R. 67:16:07:04

Current through Register Vol. 51, page 54, October 28, 2024

Section 67:16:07:04 - Services not covered

The following podiatry services are not covered under the medical assistance program:

(1) Stock orthopedic shoes, unless covered under chapter 67:16:11 for children less than twenty-one years of age, or built into a leg brace;

(2) The treatment of flatfoot;

(3) Surgical or nonsurgical treatment of subluxations of the foot, undertaken for the sole purpose of correcting a subluxated structure in the foot as an isolated entity, but not including:

(a) Surgical correction of a subluxated foot structure that is an integral part of the treatment of a foot injury; or

(b) Surgical correction of a subluxated foot structure that is undertaken to improve the function of the foot or to alleviate an inducted or associated symptomatic condition;

(4) Routine foot care, unless infected or eczematized, or the individual has been diagnosed with metabolic, neurologic, or peripheral vascular disease:

(a) Cutting or removing corns or calluses;

(b) Trimming nails;

(c) Hygienic and preventive maintenance care;

(d) Using skin creams to maintain the skin tone of ambulatory and bedfast patients; and

(e) The provision of services in the absence of localized illness, injury, or symptoms involving the foot; and

(5) Treatment of a fungal (mycotic) infection of the toenail, unless there is clinical evidence of mycosis of the toenail and medical evidence documenting that:

(a) The patient has a marked limitation of ambulation requiring active treatment of the foot; or

(b) The patient is nonambulatory and has a condition that is likely to result in significant medical complication in the absence of treatment.

S.D. Admin. R. 67:16:07:04

1 SDR 30, effective 10/13/1974; repealed, 3 SDR 26, effective 10/6/1976; readopted, 16 SDR 114, effective 1/15/1990; 16 SDR 227, effective 6/25/1990; 33 SDR 125, effective 1/31/2007; 44 SDR 94, effective 12/4/2017; 46 SDR 050, effective 10/10/2019; 49 SDR 021, effective 9/12/2022; 50 SDR 063, effective 11/27/2023

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1(1)(2).