Benefit: Podiatrist

Definition: A doctor who specializes in disorders of the foot, ankle, knee, leg and hip (collectively known as the lower extremity).

Limits:  Podiatry services are limited to:

• One podiatrist-recipient contact per day, not to exceed two per month (except for emergencies);
• One long-term care or custodial care facility service per month, per recipient, per provider or provider group (except for emergencies) with a referral from the recipient’s attending physician; and
• One new patient evaluation and management service per recipient, every three years, if no services were rendered by the podiatrist to the recipient during the three years. Subsequent encounters must be reimbursed as established patient evaluation and management services.

All elective surgical procedures require prior authorization, except for recipients 20 years of age or younger who have been screened in the Child Health Check-Up program within 12 months of the date of surgery.

Recipients are able to receive up to four podiatry visits without authorization from their MediPass provider.

Exceptions: None

Co-pays: There is a $2 beneficiary co-payment for podiatry services, per provider, per day, unless the recipient is exempt.

Reform items that can vary: None