Medicaid Benefits: Podiatrist Services
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2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 40 No - 5 NR - 6 | 2018 data limited to CN | Yes - 19 | Yes - 14 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | No | - | - | |||
| Alaska | No | - | - | |||
| Arizona | Yes | CN | No | No | - | - |
| Arkansas | Yes | CN | NR | NR | - | - |
| California | No | - | - | |||
| Colorado | Yes | CN | $2 per visit | No | - | - |
| Connecticut | Yes | CN | No | One visit per day per podiatrist and simple foot hygiene is not covered. Routine foot care defined as the following is covered: clipping or trimming of normal or mycotic toenails; debridement of the toenails that do not have onychogryphosis or onychauxis; shaving, paring, cutting or removal of keratoma, tyloma or heloma; and non definitive shaving or paring of plantar warts except for the cauterization of plantar warts. | - | - |
| Delaware | Yes | CN | No | surgical and lab test only. Routine foot care for people with circulatory or vascular disorders and diabetes | - | - |
| District of Columbia | Yes | CN | No | No | - | - |
| Florida | Yes | CN | Per provider or group provider, $2 per day | Reimbursement is limited to two visits per recipient a month, per provider or group provider. The two visits cannot be claimed for the same day. | - | - |
| Georgia | Yes | CN | $2 copay | Nail debridement limited to members with diabetes or peripheral vascular disease. | - | - |
| Hawaii | Yes | CN | No | No | - | - |
| Idaho | Yes | CN | No | No | - | - |
| Illinois | NR | NR | NR | NR | - | - |
| Indiana | Yes | CN | No | Prior authorization for inpatient hospital services and specified services associated with orthopedic shoes and appliances. Routine foot care covered only for specified systemic conditions at 6 visits/year, second opinion required for specified services. | - | - |
| Iowa | NR | NR | NR | NR | - | - |
| Kansas | No | - | - | |||
| Kentucky | Yes | CN | $3 | No routine foot care | - | - |
| Louisiana | Yes | CN | No | NR | - | - |
| Maine | Yes | CN | $.50 to $2/day depending on payment amount, up to $20/month | No | - | - |
| Maryland | Yes | CN | No | No | - | - |
| Massachusetts | Yes | CN | No | No | - | - |
| Michigan | Yes | CN | $2/visit | Debridement of mycotic nails once in a 60-day period | - | - |
| Minnesota | Yes | CN | $3 copay for non-preventive office visits | No | - | - |
| Mississippi | Yes | CN | $3 per visit | Applies to the 12 physician office visit limit per state fiscal year | - | - |
| Missouri | Yes | CN | $.50 to $3 depending on cost | NR | - | - |
| Montana | Yes | CN | Income at or below 100% FPL - $4 per visit; above FPL - 10% of payment amount | No | - | - |
| Nebraska | Yes | CN | $1 per visit | No | - | - |
| Nevada | NR | NR | NR | NR | - | - |
| New Hampshire | NR | NR | NR | NR | - | - |
| New Jersey | Yes | CN | No | No | - | - |
| New Mexico | Yes | CN | $7 for WDI recipients | No | - | - |
| New York | NR | NR | NR | NR | - | - |
| North Carolina | Yes | CN | No | MPW coverage | - | - |
| North Dakota | Yes | CN | $3 per visit | No | - | - |
| Ohio | Yes | CN | No | No | - | - |
| Oklahoma | Yes | CN | $4 per visit | Limited to medically necessary surgical procedures; medically necessary outpatient visits; and procedures generally considered as preventive foot care. All outpatient visits are subject to the existing visit limitation of 4 visits per month. | - | - |
| Oregon | Yes | CN | No | No | - | - |
| Pennsylvania | Yes | CN | Sliding scale based on the Medicaid fee for the service: $0.65 - $3.80 | No | - | - |
| Rhode Island | Yes | CN | No | No | - | - |
| South Carolina | NR | NR | NR | NR | - | - |
| South Dakota | Yes | CN | $2/procedure | Routine foot care and treatment of flat feet not covered. | - | - |
| Tennessee | Yes | CN | No | No | - | - |
| Texas | Yes | CN | No | Routine services are limited to once every 6 months. | - | - |
| Utah | Yes | CN | $4 per visit | No | - | - |
| Vermont | Yes | CN | No | Limited to non-routine foot care | - | - |
| Virginia | Yes | CN | $1 per visit | NR | - | - |
| Washington | Yes | CN | No | routine foot care is not covered | - | - |
| West Virginia | Yes | CN | No | No | - | - |
| Wisconsin | Yes | CN | $0.50 - $3.00 per service; capped at $30 per provider per calendar year | NR | - | - |
| Wyoming | No | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 48 No - 9 | Yes - 25 No - 22 | ||||
| Alabama | No | |||||
| Alaska | No | |||||
| American Samoa | No | |||||
| Arizona | No | |||||
| Arkansas | Yes | CN & MN | 2 visits/year | Fee for service, lab services reimbursed up to Medicare payment ceilings | ||
| California | Yes | CN & MN | $1/visit | Coverage limited to pregnant or institutionalized adults, other limitations vary by type of service, limited to 2 services per month in combination with services by selected other practitioners | Specified services including any services for nursing facility residents | Fee for service |
| Colorado | Yes | CN | $2/visit | Fee for service | ||
| Connecticut | Yes | CN & MN | Routine foot care only for treatment of neuro-circulatory conditions | Fee for service | ||
| Delaware | Yes | CN | Diagnostic and surgical procedures only, except routine foot care covered for specified systemic conditions | Fee for service | ||
| District of Columbia | Yes | CN & MN | Specified services | Fee for service using Medicare upper limits | ||
| Florida | Yes | CN & MN | $2/day | Visit frequency limitations based on site of service, routine foot care covered only for specified systemic conditions | Fee for service | |
| Georgia | Yes | CN & MN | $.50-$3 for selected services depending on payment rate | 12 visits/year, specified services not covered | Specified services including most services for nursing facility residents | Fee for service |
| Guam | Yes | CN | Routine foot care not covered | Fee for service using Medicare fee schedule | ||
| Hawaii | Yes | CN & MN | Routine foot care and other specified services not covered | Inpatient hospital services and appliances costing more than $100 | Fee for service | |
| Idaho | Yes | CN | $3.65/visit up to 5% of income/year across all services | Limited to treatment necessitated by specified chronic systemic conditions | Fee for service | |
| Illinois | Yes | CN & MN | $3.65/visit | Limited to treatment necessitated by specified chronic systemic conditions such as diabetes | Specified services or unusual procedures | Fee for service |
| Indiana | Yes | CN | Routine foot care covered only for specified systemic conditions at 6 visits/year, second opinion required for specified services | Inpatient hospital services and specified services associated with orthopedic shoes and appliances | Fee for service | |
| Iowa | Yes | CN & MN | $1/day | Specified services including routine foot care, treatment of flat foot or subluxation of foot and appliances not covered | Specified services | Fee for service |
| Kansas | Yes | CN & MN | 12 office visits/year included in physician limit | Fee for service | ||
| Kentucky | Yes | A, B & C - See state-specific FN | $2/visit | Specified services, orthopedic shoes and appliances not covered, routine foot care covered only for specified systemic conditions | Fee for service with upper limits set at 65% of median billed charge for ambulatory services and at 50% of median for services in inpatient hospital setting | |
| Louisiana | Yes | CN & MN | 12 ambulatory visits/year irrespective of setting included in physician visit limit, 1 inpatient hospital visit/day, specified services not covered | Specified surgical procedures | Fee for service | |
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Routine foot care covered only when specific criteria met | Specified procedures and services | Fee for service |
| Maryland | Yes | CN & MN | 1 chronic care visit/60 days, routine foot care covered only for specified systemic conditions | Fee for service | ||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | $2/visit | Routine foot care not covered | Selected procedures | Fee for service |
| Minnesota | Yes | A & B - See state-specific FN | $3/visit for non-preventive services | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | 12 visits/year included in physician visit limit, routine foot care covered only for specified systemic conditions | Fee for service using a percentage of Medicare allowable payment as ceiling | |
| Missouri | Yes | CN | $.50-$3/day, depending on payment | Specified services are no longer covered for adults who are not pregnant, blind or residing in nursing facilities | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $4/visit | Fee for service | ||
| Nebraska | Yes | CN & MN | $1/visit | 1 routine foot care visit/3 months for non-ambulatory patients and 1 visit/month for ambulatory | Fee for service | |
| Nevada | No | |||||
| New Hampshire | Yes | CN & MN | 4 visits/year, routine foot care covered only for specified systemic conditions | Fee for service | ||
| New Jersey | Yes | CN & MN - See state-specific FN | Routine foot care covered only for specified systemic conditions, 1 debridement of toenails/2 months, treatment of flat feet and subluxations not covered | Post-fracture or surgical care, orthopedic shoes and appliances | Fee for service | |
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | Coverage parameters follow Medicare criteria; A - this benefit is not covered | Specified services including routine foot care | Fee for service, some services performed in hospital setting paid 60% of fee |
| New York | No | |||||
| North Carolina | Yes | CN & MN | $3/visit | 8 visits/year included in limits with other specified practitioners and restricted to specified medical conditions - limits set annually by the legislature | Fee for service | |
| North Dakota | Yes | CN & MN | $3/visit | Fee for service | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | 24 visits/year that count toward physician visit limit | Specified services | Fee for service | |
| Oklahoma | Yes | CN | $3/visit | 4 non-emergency ambulatory visits/month included in physician limit, routine foot care covered only for specified systemic conditions | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Second opinion required for specified services, routine foot care not covered | Specified services and appliances | Fee for service, using Medicare Relative Value Units and a state conversion factor |
| Pennsylvania | Yes | CN & MN | $.65-$3.80/service, depending on payment rate | Frequency limits vary by service; routine foot care, PT, orthopedic shoes and appliances not covered | Fee for service | |
| Puerto Rico | Yes | CN & MN | Service is included in the capitated rate paid to managed care plans | |||
| Rhode Island | Yes | See state-specific FN | Specified services and appliances | Fee for service | ||
| South Carolina | No | |||||
| South Dakota | Yes | CN | $2/procedure | Routine foot care and treatment of flat feet not covered | Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures, supplies paid 90% of charge | |
| Tennessee | Yes | A, B & C - See state-specific FN | B1 - $5/visit B2 - $15/visit | See state-specific FN | ||
| Texas | Yes | CN & MN | Supportive devices not covered | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | $3/visit | A & B - Coverage limited to specified procedures, routine foot care not covered, C - Limited to medically essential procedures only | Fee for service, second and subsequent surgical procedures same session paid 50% of fee or less, rural providers may be paid higher fees | |
| Vermont | Yes | A & B - See state-specific FN | Routine foot care not covered | Fee for service, using Medicare Relative Value Units and a state conversion factor | ||
| U.S. Virgin Islands | Yes | CN | Fee for service | |||
| Virginia | Yes | CN & MN | $1/visit | Preventive and routine foot care not covered, nail trimming every 2 months covered for specified systemic conditions like diabetes | Specified services | Fee for service |
| Washington | Yes | CN & MN | Routine foot care not covered | Fee for service | ||
| West Virginia | Yes | B & C | Specified services and appliances | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service, maximum $30/year/provider | 1 routine foot care visit/61 days for specified systemic conditions, specified services not covered including treatment of flat feet | Electric bone stimulation | Fee for service |
| Wyoming | No | |||||
| Wyoming | Yes | CN | Fee for service |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 47 No - 9 | Yes - 26 No - 21 | ||||
| Alabama | No | |||||
| Alaska | No | |||||
| American Samoa | No | |||||
| Arizona | No | |||||
| Arkansas | Yes | CN & MN | 2 visits/year | Fee for service, lab services reimbursed up to Medicare payment ceilings | ||
| California | Yes | CN & MN | $1/visit | Coverage limited to pregnant or institutionalized adults, other limitations vary by type of service | Specified services including any services for nursing facility residents | Fee for service |
| Colorado | Yes | CN | $2/visit | Fee for service | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Diagnostic and surgical procedures only, except routine foot care covered for specified systemic conditions | Fee for service | ||
| District of Columbia | Yes | CN & MN | Specified services | Fee for service using Medicare upper limits | ||
| Florida | Yes | CN & MN | $2/day | Visit frequency limitations based on site of service, routine foot care covered only for specified systemic conditions | Fee for service | |
| Georgia | Yes | CN & MN | $.50-$3 for selected services depending on payment rate | 12 visits/year, specified services not covered | Specified services including most services for nursing facility residents | Fee for service, services performed in outpatient hospital rather than office paid lower fees |
| Guam | Yes | CN | Routine foot care not covered | Fee for service | ||
| Hawaii | Yes | CN & MN | Routine foot care and other specified services not covered | Inpatient hospital services and appliances costing more than $100 | Fee for service | |
| Idaho | Yes | CN | Routine foot care and other specified services not covered | Fee for service | ||
| Illinois | Yes | CN & MN | $2/visit | Specified services or unusual procedures | Fee for service | |
| Indiana | Yes | CN | Routine foot care covered only for specified systemic conditions at 6 visits/year, second opinion required for specified services | Inpatient hospital services and specified services associated with orthopedic shoes and appliances | Fee for service | |
| Iowa | Yes | CN & MN | $1/day | Specified services and appliances not covered | Specified services | Fee for service |
| Kansas | Yes | CN & MN | 12 office visits/year included in physician limit | Fee for service | ||
| Kentucky | Yes | A, B & C - See state-specific FN | $2/visit | Specified services, orthopedic shoes and appliances not covered | Fee for service with upper limits set at 65% of median billed charge for ambulatory services and at 50% of median for services in inpatient hospital setting | |
| Louisiana | Yes | CN & MN | 12 visits/year,1 inpatient hospital visit/day, specified services not covered | Specified surgical procedures | Fee for service | |
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Routine foot care covered only for specified systemic conditions | Specified procedures and services | Fee for service |
| Maryland | Yes | CN & MN | 1 chronic care visit/60 days, routine foot care covered only for specified systemic conditions | Fee for service | ||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | $2/visit | Routine foot care not covered | Selected procedures | Fee for service |
| Minnesota | Yes | A & B - See state-specific FN | B - $3/visit for non-preventive services | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | 12 visits/year included in physician visit limit, routine foot care covered only for specified systemic conditions | Fee for service using a percentage of Medicare allowable payment as ceiling | |
| Missouri | Yes | CN | $.50-$3/service, depending on payment | Specified services are no longer covered for adults who are not pregnant, blind or residing in nursing facilities | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $4/visit | Fee for service | ||
| Nebraska | Yes | CN & MN | $1/visit | 1 routine foot care visit/3 months for non-ambulatory patients and 1 visit/month for ambulatory | Fee for service | |
| Nevada | No | |||||
| New Hampshire | Yes | CN & MN | 4 visits/year, routine foot care covered only for specified systemic conditions | Fee for service | ||
| New Jersey | Yes | CN & MN - See state-specific FN | Routine foot care covered only for specified systemic conditions, 1 debridement of toenails/2 months, treatment of flat feet and subluxations not covered | Post-fracture or surgical care, orthopedic shoes and appliances | Fee for service | |
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | Coverage parameters follow Medicare criteria; A - this benefit is not covered | Specified services including routine foot care | Fee for service, some services performed in hospital setting paid 60% of fee |
| New York | No | |||||
| North Carolina | Yes | CN & MN | $3/visit | 8 visits/year included in limits with other specified practitioners - limits set annually by the legislature | Fee for service | |
| North Dakota | Yes | CN & MN | $3/visit | Fee for service | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | 24 visits/year that count toward physician visit limit | Specified services | Fee for service | |
| Oklahoma | Yes | CN | $3/visit | 4 non-emergency ambulatory visits/month included in physician limit, routine foot care covered only for specified systemic conditions | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Second opinion required for specified services, routine foot care not covered | Specified services and appliances | Fee for service, using Medicare Relative Value Units and a state conversion factor |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment rate | Frequency limits vary by service; routine foot care, PT, orthopedic shoes and appliances not covered | Fee for service | |
| Puerto Rico | Yes | CN & MN | Service is included in the capitated rate paid to managed care plans | |||
| Rhode Island | Yes | See state-specific FN | Specified services and appliances | Fee for service | ||
| South Carolina | Yes | CN | $1/visit | 12 visits/year, visits count toward physician visit limit | Fee for service | |
| South Dakota | Yes | CN | $2/procedure | Routine foot care and treatment of flat feet not covered | Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures, supplies paid 90% of charge | |
| Tennessee | Yes | A & B - See state-specific FN | B1 - $5/visit B2 - $10/visit | See state-specific FN | ||
| Texas | Yes | CN & MN | Supportive devices not covered | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | $3/visit | A & B - Coverage limited to specified procedures, routine foot care not covered, C - Limited to medically essential procedures only | Fee for service, second and subsequent surgical procedures same session paid 50% of fee or less, rural providers may be paid higher fees | |
| Vermont | Yes | A & B - See state-specific FN | Routine foot care not covered | Fee for service, using Medicare Relative Value Units and a state conversion factor | ||
| U.S. Virgin Islands | Yes | CN | Fee for service | |||
| Virginia | Yes | CN & MN | $1/visit | Preventive and routine foot care not covered | Specified services | Fee for service |
| Washington | Yes | CN & MN | Routine foot care not covered | Fee for service | ||
| West Virginia | Yes | B & C | Specified services and appliances | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service, maximum $30/year/provider | 1 routine foot care visit/61 days for specified systemic conditions, specified services not covered including treatment of flat feet | Electric bone stimulation | Fee for service |
| Wyoming | No |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 48 No - 8 | Yes - 26 No - 22 | ||||
| Alabama | No | |||||
| Alaska | No | |||||
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | Routine foot care covered only for specified systemic conditions and limited to 2 visits/3 months | Yes | Fee for service | |
| Arkansas | Yes | CN & MN | 2 visits/year | Fee for service, lab services reimbursed up to Medicare payment ceilings | ||
| California | Yes | CN & MN | $1/visit | Limitations vary by type of service | Specified services including any services for nursing facility residents | Fee for service |
| Colorado | Yes | CN | $2/visit | Fee for service | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Diagnostic and surgical procedures only, except routine foot care covered only for specified systemic conditions | Fee for service | ||
| District of Columbia | Yes | CN & MN | Specified services | Fee for service using Medicare upper limits | ||
| Florida | Yes | CN & MN | $2/day | Visit frequency limitations based on site of service, routine foot care covered only for specified systemic conditions | Fee for service | |
| Georgia | Yes | CN & MN | $.50-$3 for selected services depending on payment rate | 12 visits/year, specified services not covered | Specified services including most services for nursing facility residents | Fee for service, services performed in outpatient hospital rather than office paid lower fees |
| Guam | Yes | CN | Routine foot care not covered | Fee for service | ||
| Hawaii | Yes | CN & MN | Routine foot care and other specified services not covered | Inpatient hospital services and appliances costing more than $100 | Fee for service | |
| Idaho | Yes | CN | Routine foot care and other specified services not covered | Fee for service | ||
| Illinois | Yes | CN & MN | $2/visit | Specified services or unusual procedures | Fee for service | |
| Indiana | Yes | CN | Routine foot care covered only for specified systemic conditions at 6 visits/year, second opinion required for specified services | Inpatient hospital services and specified services associated with orthopedic shoes and appliances | Fee for service | |
| Iowa | Yes | CN & MN | $1/day | Specified services and appliances not covered | Specified services | Fee for service |
| Kansas | Yes | CN & MN | 12 office visits/year included in physician limit | Fee for service | ||
| Kentucky | Yes | A, B & C - See state-specific FN | $2/visit | Specified services, orthopedic shoes and appliances not covered | Fee for service with upper limits set at 65% of median billed charge for ambulatory services and at 50% of median for services in inpatient hospital setting | |
| Louisiana | Yes | CN & MN | 12 visits/year,1 inpatient hospital visit/day, specified services not covered | Specified surgical procedures | Fee for service | |
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Routine foot care covered only for specified systemic conditions | Specified procedures and services | Fee for service |
| Maryland | Yes | CN & MN | 1 chronic care visit/2 months, routine foot care covered only for specified systemic conditions | Fee for service | ||
| Massachusetts | Yes | CN & MN | Limited to services medically necessary for life and safety | Fee for service | ||
| Michigan | Yes | CN & MN | $2/visit | Routine foot care not covered | Selected procedures | Fee for service |
| Minnesota | Yes | A & B - See state-specific FN | $3/visit for non-preventive services | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | 12 visits/year included in physician visit limit, routine foot care covered only for specified systemic conditions | Fee for service using a percentage of Medicare allowable payment as ceiling | |
| Missouri | Yes | CN | $.50-$3/service, depending on payment | Specified services are no longer covered for adults who are not pregnant, blind or residing in nursing facilities | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $4/visit | Fee for service | ||
| Nebraska | Yes | CN & MN | $1/visit | 1 routine foot care visit/3 months for non-ambulatory patients and 1 visit/month for ambulatory | Fee for service | |
| Nevada | No | |||||
| New Hampshire | Yes | CN & MN | 12 visits/year, routine foot care covered only for specified systemic conditions | Fee for service | ||
| New Jersey | Yes | CN & MN - See state-specific FN | Routine foot care covered only for specified systemic conditions, 1 debridement of toenails/2 months, treatment of flat feet and subluxations not covered | Post-fracture or surgical care, orthopedic shoes and appliances | Fee for service | |
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | Coverage parameters follow Medicare criteria | Specified services including routine foot care | Fee for service, some services performed in hospital setting paid 60% of fee |
| New York | No | |||||
| North Carolina | Yes | CN & MN | $3/visit | 8 visits/year included in limits with other specified practitioners - limits set annually by the legislature | Fee for service | |
| North Dakota | Yes | CN & MN | $3/visit | Fee for service | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | 24 visits/year that count toward physician visit limit | Specified services | Fee for service | |
| Oklahoma | Yes | CN | $1/service | 4 non-emergency ambulatory visits/month included in physician limit, routine foot care covered only for specified systemic conditions | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Second opinion required for specified services, routine foot care not covered | Specified services and appliances | Fee for service, second and subsequent surgical procedures same session paid 50% of fee or less, drugs, supplies and appliances paid cost |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment rate | Frequency limits vary by service; routine foot care, physical therapy, orthopedic shoes and appliances not covered | Fee for service | |
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | Yes | CN - see state-specific FN | Specified services and appliances | Fee for service | ||
| South Carolina | Yes | CN | $1/visit | 12 visits/year, visits count toward physician visit limit | Fee for service | |
| South Dakota | Yes | CN | $2/procedure | Routine foot care and treatment of flat feet not covered | Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures, supplies paid 90% of charge | |
| Tennessee | Yes | A & B - See state-specific FN | B1 - $5/visit, B2 - $10/visit | |||
| Texas | Yes | CN & MN | Fee for service | |||
| Utah | Yes | A, B & C - See state-specific FN | $3/visit | A & B - Coverage limited to specified procedures, routine foot care not covered, C - Limited to medically essential procedures only | Fee for service, second and subsequent surgical procedures same session paid 50% of fee or less, rural providers may be paid higher fees | |
| Vermont | Yes | A & B - See state-specific FN | Routine foot care not covered | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Fee for service | |||
| Virginia | Yes | CN & MN | $1/visit | Preventive and routine foot care not covered | Specified services | Fee for service |
| Washington | Yes | CN & MN | Routine foot care not covered | Fee for service | ||
| West Virginia | Yes | B &C | Specified services and appliances | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service, maximum $30/year/provider | 1 routine foot care visit/61 days for specified systemic conditions, specified services not covered including treatment of flat feet | Electric bone stimulation | Fee for service |
| Wyoming | No |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 48 No - 8 | Yes - 26 No - 22 | ||||
| Alabama | No | |||||
| Alaska | No | |||||
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | Routine foot care covered only for specified systemic conditions and limited to 2 visits/3 months | Yes | Fee for service | |
| Arkansas | Yes | CN & MN | 2 visits/year | Fee for service, lab services reimbursed up to Medicare payment ceilings | ||
| California | Yes | CN & MN | $1/visit | Limitations vary by type of service | Specified services including any services for nursing facility residents | Fee for service |
| Colorado | Yes | CN | $2/visit | Fee for service | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Diagnostic and surgical procedures only, except routine foot care covered only for specified systemic conditions | Fee for service | ||
| District of Columbia | Yes | CN & MN | Specified services | Fee for service using Medicare upper limits | ||
| Florida | Yes | CN & MN | $2/day | Visit frequency limitations based on site of service, routine foot care covered only for specified systemic conditions | Fee for service | |
| Georgia | Yes | CN & MN | $.50-$3 for selected services depending on payment rate | 12 visits/year, specified services not covered | Specified services including most services for nursing facility residents | Fee for service, services performed in outpatient hospital rather than office paid lower fees |
| Guam | Yes | CN | Routine foot care not covered | Fee for service | ||
| Hawaii | Yes | CN & MN | Routine foot care and other specified services not covered | Inpatient hospital services and appliances costing more than $100 | Fee for service | |
| Idaho | Yes | CN | Routine foot care and other specified services not covered | Fee for service | ||
| Illinois | Yes | CN & MN | $2/visit | Specified services or unusual procedures | Fee for service | |
| Indiana | Yes | CN | Routine foot care covered only for specified systemic conditions at 6 visits/year, second opinion required for specified services | Inpatient hospital services and specified services associated with orthopedic shoes and appliances | Fee for service | |
| Iowa | Yes | CN & MN | $1/day | Specified services and appliances not covered | Specified services | Fee for service |
| Kansas | Yes | CN & MN | 12 office visits/year included in physician limit, 2 nursing facility or ICF/MR visits/year | Fee for service | ||
| Kentucky | Yes | A, B & C - See state-specific FN | $2/visit | Specified services, orthopedic shoes and appliances not covered | Fee for service with upper limits set at 65% of median billed charge for ambulatory services and at 50% of median for services in inpatient hospital setting | |
| Louisiana | Yes | CN & MN | 12 visits/year,1 inpatient hospital visit/day, specified services not covered | Specified surgical procedures | Fee for service | |
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Routine foot care covered only for specified systemic conditions and limited to 2 treatments/3 months up to 8/year, 1 mycotic nail treatment/2 months | Specified procedures and services | Fee for service |
| Maryland | Yes | CN & MN | 1 chronic care visit/2 months, routine foot care covered only for specified systemic conditions | Fee for service | ||
| Massachusetts | Yes | CN & MN | Limited to services medically necessary for life and safety | Fee for service | ||
| Michigan | Yes | CN & MN | $2/visit | Routine foot care not covered | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | $3/visit for non-preventive services | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | 12 visits/year included in physician visit limit, routine foot care covered only for specified systemic conditions | Fee for service using a percentage of Medicare allowable payment as ceiling | |
| Missouri | Yes | CN | $.50-$3/service, depending on payment | Specified services are no longer covered for adults who are not pregnant, blind or residing in nursing facilities | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $4/visit | Fee for service | ||
| Nebraska | Yes | CN & MN | $1/visit | 1 routine foot care visit/3 months for non-ambulatory patients and 1 visit/month for ambulatory | Fee for service | |
| Nevada | No | |||||
| New Hampshire | Yes | CN & MN | 12 procedures or visits/year, routine foot care covered only for specified systemic conditions | Fee for service | ||
| New Jersey | Yes | CN & MN - See state-specific FN | Routine foot care covered only for specified systemic conditions, 1 debridement of toenails/2 months, treatment of flat feet and subluxations not covered | Post-fracture or surgical care, orthopedic shoes and appliances | Fee for service | |
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | Coverage parameters follow Medicare criteria | Specified services including routine foot care | Fee for service, some services performed in hospital setting paid 60% of fee |
| New York | No | |||||
| North Carolina | Yes | CN & MN | $3/visit | 24 ambulatory visits/year included in limits with other specified practitioners, routine foot care covered only for specified systemic conditions | Fee for service | |
| North Dakota | Yes | CN & MN | $3/visit | Fee for service | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | 24 visits/year that count toward physician visit limit | Fee for service | ||
| Oklahoma | Yes | CN | $1/service | Routine foot care covered only for specified systemic conditions | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Second opinion required for specified services, routine foot care not covered | Specified services and appliances | Fee for service, second and subsequent surgical procedures same session paid 50% of fee or less, drugs, supplies and appliances paid cost |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment | Frequency limits vary by service; routine foot care, physical therapy, orthopedic shoes and appliances not covered | Fee for service, with payment ceilings for services provided in inpatient or outpatient hospital setting | |
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | Yes | CN - see state-specific FN | Specified services and appliances | Fee for service | ||
| South Carolina | Yes | CN | $1/visit | Fee for service | ||
| South Dakota | Yes | CN | $2/procedure | Routine foot care and treatment of flat feet not covered | Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures, supplies paid 90% of charge | |
| Tennessee | Yes | A & B - See state-specific FN | B1 - $5/visit, B2 - $10/visit | |||
| Texas | Yes | CN & MN | Fee for service | |||
| Utah | Yes | A, B & C - See state-specific FN | $3/visit | A & B - Coverage limited to specified procedures, routine foot care not covered, C - Limited to medically essential procedures only | Fee for service, second and subsequent surgical procedures same session paid 50% of fee or less, rural providers may be paid higher fees | |
| Vermont | Yes | A & B - See state-specific FN | Routine foot care not covered | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Fee for service | |||
| Virginia | Yes | CN & MN | $1/visit | Preventive and routine foot care not covered | Fee for service | |
| Washington | Yes | CN & MN | Routine foot care not covered | Fee for service | ||
| West Virginia | Yes | CN & MN | 40 visits/year | Specified services and appliances | Fee for service | |
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service, maximum $30/year/provider | 1 routine foot care visit/61 days for specified systemic conditions, specified services not covered including treatment of flat feet | Electric bone stimulation | Fee for service |
| Wyoming | No |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 47 No - 9 | Yes - 24 No - 23 | ||||
| Alabama | No | |||||
| Alaska | No | |||||
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | Yes | Fee for service | ||
| Arkansas | Yes | CN & MN | 2 visits/year | Fee for service, lab services reimbursed up to Medicare payment ceilings | ||
| California | Yes | CN & MN | $1/visit | Limitations vary by type of service | Specified services including any services for nursing facility residents | Fee for service |
| Colorado | Yes | CN | $2/visit | Fee for service | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Diagnostic and surgical procedures only, except routine foot care covered only for specified systemic conditions | Fee for service | ||
| District of Columbia | Yes | CN & MN | Specified services | Fee for service using Medicare upper limits | ||
| Florida | Yes | CN & MN | $2/day | Visit frequency limitations based on site of service, routine foot care not covered | Elective procedures | Fee for service |
| Georgia | Yes | CN & MN | $2/visit | 12 visits/year, 1 inpatient hospital visit/day, specified services not covered | Specified services including most services for nursing facility residents | Fee for service, services performed in outpatient hospital rather than office paid lower fees |
| Guam | Yes | CN | Routine foot care not covered | Fee for service | ||
| Hawaii | Yes | CN & MN | Routine foot care and other specified services not covered | Inpatient hospital services and appliances costing more than $100 | Fee for service | |
| Idaho | Yes | CN | Routine foot care and other specified services not covered | Fee for service | ||
| Illinois | Yes | CN & MN | $2/visit | Specified services or unusual procedures | Fee for service | |
| Indiana | Yes | CN | Routine foot care covered only for specified systemic conditions at 6 visits/year, second opinion required for specified services | Inpatient hospital services and specified services associated with orthopedic shoes and appliances | Fee for service | |
| Iowa | Yes | CN & MN | $1/day | Specified services and appliances not covered | Specified services | Fee for service |
| Kansas | Yes | CN & MN | 12 office visits/year included in physician limit, 2 nursing facility or ICF/MR visits/year | Fee for service | ||
| Kentucky | Yes | CN & MN | $2/visit | Specified services, orthopedic shoes and appliances not covered | Fee for service with upper limits set at 65% of median billed charge for ambulatory services and at 50% of median for services in inpatient hospital setting | |
| Louisiana | Yes | CN & MN | 12 visits/year,1 inpatient hospital visit/day, specified services not covered | Specified surgical procedures | Fee for service | |
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Routine foot care covered only for specified systemic conditions and limited to 2 treatments/3 months up to 8/year, 1 mycotic nail treatment/2 months | Specified procedures and services | Fee for service |
| Maryland | Yes | CN & MN | 1 chronic care visit/2 months, routine foot care covered only for specified systemic conditions | Fee for service | ||
| Massachusetts | Yes | CN & MN | Limited to services medically necessary for life and safety | Fee for service | ||
| Michigan | Yes | CN & MN | $2/visit | Routine foot care covered only for specified systemic conditions | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | $3/visit for non-preventive service | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | 12 visits/year included in physician visit limit, routine foot care covered only for specified systemic conditions | Fee for service using a percentage of Medicare allowable payment as ceiling | |
| Missouri | Yes | CN | $.50-$3/service, depending on payment | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $4/visit | Fee for service | ||
| Nebraska | Yes | CN & MN | $1/visit | 1 routine foot care visit/3 months for non-ambulatory patients and 1 visit/month for ambulatory | Fee for service | |
| Nevada | No | |||||
| New Hampshire | Yes | CN & MN | 12 procedures or visits/year, routine foot care covered only for specified systemic conditions | Fee for service | ||
| New Jersey | Yes | CN & MN - See state-specific FN | Routine foot care covered only for specified systemic conditions, 1 debridement of toenails/2 months, treatment of flat feet and subluxations not covered | Post-fracture or surgical care, orthopedic shoes and appliances | Fee for service | |
| New Mexico | Yes | CN | B - $7/visit - see state-specific FN | Coverage parameters follow Medicare criteria | Specified services including routine foot care | Fee for service, some services performed in hospital setting paid 60% of fee |
| New York | No | |||||
| North Carolina | Yes | CN & MN | $1/visit | 24 ambulatory visits/year included in limits with other specified practitioners, routine foot care covered only for specified systemic conditions | Fee for service | |
| North Dakota | Yes | CN & MN | $3/visit | Fee for service | ||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | 24 visits/year that count toward physician visit limit | Fee for service | ||
| Oklahoma | Yes | CN | $1/service | Routine foot care covered only for specified systemic conditions | Fee for service | |
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Second opinion required for specified services, routine foot care not covered | Specified services and appliances | Fee for service, second and subsequent surgical procedures same session paid 50% of fee or less, drugs, supplies and appliances paid cost |
| Pennsylvania | Yes | CN & MN | Routine foot care, physical therapy, orthopedic shoes and appliances not covered | Fee for service, with payment ceilings for services provided in inpatient or outpatient hospital setting | ||
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | Yes | CN - see state-specific FN | Specified services and appliances | Fee for service | ||
| South Carolina | Yes | CN | $1/visit | Fee for service | ||
| South Dakota | Yes | CN | Routine foot care and treatment of flat feet not covered | Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures, supplies paid 90% of charge | ||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $5/visit, B2 - $10/visit | |||
| Texas | No | |||||
| Utah | Yes | A, B & C - See state-specific FN | $3/visit | A & B - Coverage limited to specified procedures, routine foot care not covered, C - Limited to medically essential procedures only | Fee for service, second and subsequent surgical procedures same session paid 50% of fee or less, rural providers may be paid higher fees | |
| Vermont | Yes | A & B - See state-specific FN | Routine foot care not covered | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Fee for service | |||
| Virginia | Yes | CN & MN | $1/visit | Preventive and routine foot care not covered | Fee for service | |
| Washington | Yes | CN & MN | Routine foot care not covered | Fee for service | ||
| West Virginia | Yes | CN & MN | 40 visits/year | Specified services and appliances | Fee for service | |
| Wisconsin | Yes | CN & MN | $.50-$3, depending on service, maximum $30/year/provider | 1 routine foot care visit/61 days for specified systemic conditions, specified services not covered including treatment of flat feet | Electric bone stimulation | Fee for service |
| Wyoming | No |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 49 No - 7 | Yes - 22 No - 27 | ||||
| Alabama | No | |||||
| Alaska | No | |||||
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | Yes | Fee for service | ||
| Arkansas | Yes | CN & MN | 2 visits/year | Fee for service, lab services reimbursed up to Medicare payment ceilings | ||
| California | Yes | CN & MN | $1/visit | Limitations vary by type of service | Specified services including any services for nursing facility residents | Fee for service |
| Colorado | Yes | CN | $2/visit | Fee for service | ||
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Diagnostic and surgical procedures only, except routine foot care covered only for specified systemic conditions | Fee for service | ||
| District of Columbia | Yes | CN & MN | Specified services | Fee for service using Medicare upper limits | ||
| Florida | Yes | CN & MN | $2/day | Visit frequency limitations based on site of service, routine foot care not covered | Elective surgical procedures | Fee for service |
| Georgia | Yes | CN & MN | $2/visit | 12 visits/year, 1 inpatient hospital visit/day, specified services not covered | Specified services including most services for nursing facility residents | Fee for service, services performed in outpatient hospital rather than office paid lower fees |
| Guam | Yes | CN | Routine foot care not covered | Fee for service | ||
| Hawaii | Yes | CN & MN | Routine foot care and other specified services not covered | Inpatient hospital services and appliances costing more than $100 | Fee for service | |
| Idaho | Yes | CN | Routine foot care and other specified services not covered | Fee for service | ||
| Illinois | Yes | CN & MN | $2/visit | Specified services or unusual procedures | Fee for service | |
| Indiana | Yes | CN | Routine foot care covered only for specified systemic conditions at 6 visits/year, second opinion required for specified services | Inpatient hospital services and specified services associated with orthopedic shoes and appliances | Fee for service | |
| Iowa | Yes | CN & MN | $1/day | Specified services and appliances not covered | Specified services | Fee for service |
| Kansas | Yes | CN & MN | 12 office visits/year included in physician limit, 2 nursing facility or ICF/MR visits/year | Fee for service | ||
| Kentucky | Yes | CN & MN | Specified services, orthopedic shoes and appliances not covered | Fee for service with upper limits set at 65% of median billed charge for ambulatory services and at 50% of median for services in inpatient hospital setting | ||
| Louisiana | Yes | CN & MN | 12 visits/year,1 inpatient hospital visit/day, specified services not covered | Specified surgical procedures | Fee for service | |
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Routine foot care covered only for specified systemic conditions | Specified procedures and services | Fee for service |
| Maryland | Yes | CN & MN | 1 chronic care visit/2 months, routine foot care covered only for specified systemic conditions | Fee for service | ||
| Massachusetts | Yes | CN & MN | Limited to services medically necessary for life and safety | Fee for service | ||
| Michigan | Yes | CN & MN | $2/visit | Routine foot care covered only for specified systemic conditions | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | A - $3/visit for non-preventive service | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | 12 visits/year included in physician visit limit, routine foot care covered only for specified systemic conditions | Fee for service using a percentage of Medicare allowable payment as ceiling | |
| Missouri | Yes | CN | $1/visit (non-emergency outpatient hospital service only) | Fee for service | ||
| Montana | Yes | CN & MN | $4/visit | Fee for service | ||
| Nebraska | Yes | CN & MN | $1/visit | 1 routine foot care visit/3 months for non-ambulatory patients and 1 visit/month for ambulatory | Fee for service | |
| Nevada | No | |||||
| New Hampshire | Yes | CN & MN | 12 procedures or visits/year, routine foot care covered only for specified systemic conditions | Fee for service | ||
| New Jersey | Yes | CN & MN - See state-specific FN | Routine foot care covered only for specified systemic conditions, 1 debridement of toenails/2 months, treatment of flat feet and subluxations not covered | Post-fracture or surgical care, orthopedic shoes and appliances | Fee for service | |
| New Mexico | Yes | CN | B - $5/visit - see state-specific FN | Coverage parameters follow Medicare criteria | Specified services including routine foot care | Fee for service, some services performed in hospital rather than office paid 60% of fee |
| New York | No | |||||
| North Carolina | Yes | CN & MN | $1/visit | 24 ambulatory visits/year included in limits with other specified practitioners, routine foot care covered only for specified systemic conditions | Fee for service | |
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | No | |||||
| Ohio | Yes | CN | 24 ambulatory visits/year included in limits with physicians | Fee for service | ||
| Oklahoma | Yes | CN & MN | $1/service | Routine foot care covered only for specified systemic conditions | Fee for service | |
| Oregon | Yes | CN & MN | $3/visit | Second opinion required for specified services, routine foot care not covered | Specified services and appliances | Fee for service, second and subsequent surgical procedures same session paid 50% of fee or less, drugs, supplies and appliances paid cost |
| Pennsylvania | Yes | CN & MN | Routine foot care, physical therapy, orthopedic shoes and appliances not covered | Fee for service, with payment ceilings for services provided in inpatient or outpatient hospital setting | ||
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | Yes | CN - see state-specific FN | Specified services and appliances | Fee for service | ||
| South Carolina | Yes | CN | Fee for service | |||
| South Dakota | Yes | CN | Routine foot care and treatment of flat feet not covered | Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures, supplies paid 90% of charge | ||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $5/visit, B2 - $10/visit | |||
| Texas | Yes | CN & MN | Fee for service | |||
| Utah | Yes | A, B & C - See state specific FN | $2/visit | A & B - Coverage limited to pregnant women, routine foot care not covered, C - Limited to medically essential procedures only | Fee for service, second and subsequent surgical procedures same session paid 50% of fee or less, rural providers may be paid higher fees | |
| Vermont | Yes | A & B - See state-specific FN | B - $7/visit | Routine foot care not covered | Fee for service | |
| U.S. Virgin Islands | Yes | CN | Fee for service | |||
| Virginia | Yes | CN & MN | $1/visit | Preventive and routine foot care not covered | Fee for service | |
| Washington | Yes | CN & MN | Routine foot care not covered | Fee for service | ||
| West Virginia | Yes | CN & MN | Specified services and appliances | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3/ service depending on payment | 1 routine foot care visit/61 days for specified systemic conditions, specified services not covered including treatment of flat feet | Electric bone stimulation | Fee for service |
| Wyoming | No |