Page 93

UNOFFICIAL 1737-93 (1) Professional services, not involving surgery, provided in the office and clinic; professional services, not involving surgery,

related to diabetic foot care in the outpatient and inpatient hospital, skilled

nursing facility, and intermediate care facility under the following conditions: (A) Podiatry services, not involving surgery, in a hospital (inpatient or outpatient), skilled nursing facility, and intermediate care facility shall be considered as adjuncts to general medical care and limited to diabetic foot care; (B) In the case of a patient requiring inpatient hospital care, podiatry services shall be limited to diabetic foot care only, must be ordered by the attending physician as noted by the physician in the medical chart, and may be furnished after obtaining prior authorization from the department's medical consultant; and (C) In the case of a patient requiring podiatry services in a skilled nursing or an intermediate care facility, podiatry services shall be limited to diabetic foot care only and must be ordered by the attending physician as noted by the physician in the medical chart; (2) Surgical procedures are limited to those involving the ankle and below; surgical procedures performed in the office, clinic, and skilled nursing or intermediate care facility with costs greater than $100 require prior authorization from the department's medical consultant or agent. All surgical procedures performed in the outpatient hospital require prior authorization from the department's medical consultants; (3) Diagnostic radiology procedures limited to the ankle and below; (4) Foot appliances (orthoses, prostheses); (5) Orthopedic shoes and casts; and (6) Orthodigital prostheses and casts.

(c) Foot and ankle care related to the treatment of infection or injury is covered in the office or an outpatient clinic setting.