Consultation Services Rendered by a Podiatrist in a Skilled Nursing Facility

CMS National Coverage Determination | ncd_id=170 | manual_section=70.2 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False

Consultation services rendered by a podiatrist in a skilled nursing facility are covered if the services are reasonable and necessary and do not come within any of the specific statutory exclusions. Section 1862(a)(13) of the Act excludes payment for the treatment of flat foot conditions, the treatment of subluxations of the foot, and routine foot care. To determine whether the consultation comes within the foot care exclusions, apply the same rule as for initial diagnostic examinations, i.e., where services are performed in connection with specific symptoms or complaints which suggest the need for covered services, the services are covered regardless of the resulting diagnosis. The exclusion of routine physician examinations is also pertinent and would generally exclude podiatric consultation performed on all patients in a skilled nursing facility on a routine basis for screening purposes, except in those cases where a specific foot ailment is involved. Section 1862(a)(7) of the Act excludes payment for routine physical checkups.

Cross Reference: Medicare Benefit Policy Manual , Chapter 16 Revision History: 05/1989 - Added statutory authority citation. Effective date NA. (TN 36) Benefit Categories: 52 - Physicians' Services Transmittal: transmittal_number=36 | transmittal_issue_date=1989-05-01