LCD/NCD Portal

NCD70.2

 

CONSULTATION SERVICES RENDERED BY A PODIATRIST IN A SKILLED NURSING FACILITY

 

 

Effective Date of this Version

• This is a longstanding national coverage determination.

• The effective date of this version has not been posted.

 

Benefit Category

• Physicians' Services

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Indications and Limitations of Coverage

• 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.

o Where services are performed in connection with specific symptoms.

o 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,

 

 

Medicare NCD Link