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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Podiatry Services

DMA Clinical Policy and Programs
Phone Number 919-855-4320
Fax 919-733-2796

Podiatry, as defined by NCGS 90-202.2, “is the surgical, medical, or mechanical treatment of allailments of the human foot and ankle, and their related soft tissue structure to the level of the myotendinous junction. Excluded from the definition of podiatry is the amputation of the entire foot, the administration of an anesthetic other than a local, and the surgical correction of clubfoot of an infant two years of age or less.”

Medically necessary routine foot care is the cutting or removal of corns and calluses; trimming, cutting, clipping, or debriding of nails; and other hygienic care due to a physical or clinical finding that is consistent with a metabolic, neurological, and/or peripheral vascular disease diagnosis and indicative of severe peripheral involvement. Note: In the absence of medical necessity, these services are considered routine and are not covered by the N.C. Medicaid program.

Prior Approval

Please note that both Podiatry and Medically Necessary Routine Food Care require Prior Approval (PA) for Medicaid for Pregnant Women (MPW) beneficiaries as stated in both policies in Section 5.1:

  • Clinical Coverage Policy 1C-1, Section 5.1
  • Prior approval for podiatry services is not required, except for recipients with MPW coverage, to document medical necessity for services related to pregnancy or due to complications of pregnancy. Prior approval is obtained using the Medicaid Request for Prior Approval Form 372-118.

  • Clinical Coverage Policy 1C-2, Section 5.1
  • Prior approval for medically necessary routine foot care is not required, except for recipients with Medicaid for Pregnant Women coverage, to document medical necessity for services related to pregnancy or due to complications of pregnancy. Prior approval is obtained using the Medicaid Request for Prior Approval Form 372-118.

Medicaid Bulletins

For changes and updates to coverage criteria, billing information, and other program requirements refer to the N.C. Medicaid general and special bulletins.

Physician Services (CPT/HCPCS) Fee Schedules

 

 

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