5101:3-7-04 Podiatric medicine: noncovered services.

(A) The following services are noncovered:

(1) All services exceeding the policies and limitations defined in Chapters 5101:3-4 and 5101:3-7 of the Administrative Code.

(2) Services determined by the department as not medically necessary as defined in Chapter 5101:3-1 of the Administrative Code.

(3) Services of a preventive nature.

(B) In addition, the following services are noncovered, unless a consumer has a localized infection or is under the care of an eligible prescriber for a metabolic disease such as diabetes mellitus, or another condition that may result in a circulatory impairment or desensitization in the legs or feet:

(1) Examinations and diagnostic services associated with routine foot care performed in the absence of a localized illness, symptoms or injury;

(2) Cutting or removal of corns and calluses;

(3) Nail trimming, cutting or clipping of nails not associated with nail surgery, unless a systemic condition is present such as metabolic, neurologic, or peripheral vascular disease that may require scrupulous foot care by a professional an eligible prescriber;

(4) Foot care provided for hygienic services;

(5) The treatment of uncomplicated, chronic foot conditions such as flat feet or a sublaxated structure in the foot; and

(6) Treatment of mycotic nails for an ambulatory and nonambulatory consumer unless the eligible prescriber attending the patient's mycotic condition documents that:

(a) There is clinical evidence of onychomycosis of the toenail; and

(b) The consumer has mycosis/dystrophy of the toenail causing secondary infection and/or pain that results or would result in marked limitation of ambulation and require the professional skills of a podiatrist podiatric physician.

Effective: 11/04/2010
R.C. 119.032 review dates: 07/29/2010 and 11/01/2015
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 4/7/77, 5/19/86, 9/1/89, 2/1/90, 1/1/01, 8/15/05