Section 85.35 - Podiatry services

85.35 Podiatry services. (a) Qualified podiatrist.

(1) A podiatrist qualified to participate in the medical assistance program means a podiatrist who is licensed and currently registered to practice podiatry in New York State by the State Education Department.

(2) Podiatry services provided to eligible medical assistance patients while temporarily out-of-state shall be provided by podiatrists qualified to practice podiatry by the appropriate licensing agency of the state in which podiatry services are provided.

(b) Podiatry services included as covered benefits. (1) Podiatry care, services and supplies shall be made available as medically needed and as an integral part of comprehensive medical care.

(2) Necessary podiatry care, services and supplies means those services provided by qualified podiatrists.

(3) Podiatry care, services and supplies shall also include the provision of, or ordering of, clinical laboratory tests that are related to the scope of podiatric practice permitted under provisions of article 141 (Podiatry) of the State Education Law, book 16, McKinney's Consolidated Laws of New York, West Publishing Co., St. Paul, MN, and the rules and regulations of the State Education Department (8 NYCRR Part 65). Copies of these statutory and regulatory provisions are available for inspection and copying at the offices of the records access officer of the Department of Health, Corning Tower, Empire State Plaza, Albany, NY.

(4) Clinical laboratory tests provided or ordered by qualified podiatrists shall be limited to those tests necessary for the diagnosis or treatment of conditions of the foot. Such tests, when performed in the office of the podiatrist in the course of treatment of his own patients, shall be limited to:

(i) complete blood count or any of the separate components of such analysis, including red cell count, white cell count, or hemoglobin;

(ii) hematocrit;

(iii) sedimentation rate;

(iv) urine analysis, routine chemical; and

(v) urine analysis, routine microscopic.

(5) All other necessary clinical laboratory tests shall be performed in a clinical laboratory holding a valid clinical laboratory permit issued in accordance with provisions of the Public Health Law, in the categories for which payment is requested from medical assistance program funds.

(6) All necessary radiologic procedures shall be made available as a covered benefit. Radiologic procedures mean X-rays used to establish a podiatric diagnosis or foot-related medical problem and may be used in conjunction with necessary treatment of foot conditions.

(c) Podiatry service limitations. (1) Medical assistance podiatry care, services and supplies shall not include:

(i) routine hygienic care of the feet in the absence of pathology;

(ii) clinical laboratory tests except those permitted in paragraphs (b)(4) and (5) of this section;

(iii) radiologic procedures outside the scope of podiatric practice as per paragraph (b)(6) of this section;

(iv) amputations and bunion operations, unless such procedures are provided in a hospital; or

(v) all podiatric prostheses in excess of $100 unless prior approval of the local professional director and prior authorization of the local social services commissioner is given.

(d) Reimbursement. Reimbursement for podiatry services shall be made in accordance with fees developed by the New York State Department of Health and approved by the New York State Division of the Budget.
 

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