907 KAR 1:270.
Podiatry Program services.
RELATES TO: KRS
205.520, 42 C.F.R. 440.60, 42 U.S.C. 1396a, b, d
KRS 194A.030(2), 194A.050(1), 205.520(3), EO 2004-726
AND CONFORMITY: EO 2004-726, effective July 9, 2004, reorganized the Cabinet
for Health Services and placed the Department for Medicaid Services and the
Medicaid Program under the Cabinet for Health and Family Services. The Cabinet
for Health and Family Services, Department for Medicaid Services, has responsibility
to administer the Medicaid Program. KRS 205.520(3) authorizes the cabinet, by
administrative regulation, to comply with a requirement that may be imposed or
opportunity presented by federal law for the provision of medical assistance to
Kentucky's indigent citizenry. This administrative regulation establishes the
coverage provisions relating to podiatry services for which payment shall be
made by the Medicaid Program on behalf of both categorically needy and medically
Section 1. Coverage.
The Medicaid program shall cover a medical or surgical service provided to an
eligible Medicaid recipient by a licensed, participating podiatrist if the
service falls within the scope of the practice of podiatry except as provided
in Section 2 of this administrative regulation.
Exclusions From Coverage; Exceptions. Except as provided in this section, the
following areas of care shall not be covered:
(1) Routine foot
(a) Except as
provided in paragraph (b) of this subsection and subsection (2) of this
section, a service characterized as routine foot care shall not be covered.
Routine foot care shall include:
1. The cutting or
removal of a corn or callus;
2. The trimming of a
3. Other hygienic or
preventive maintenance care in the realm of self-care including:
a. Cleaning or
soaking a foot;
b. The use of a skin
cream to maintain skin tone of an ambulatory or bedfast patient; or
c. A service
performed in the absence of localized illness, injury or symptom involving the
(b) If the patient
has a systematic disease of sufficient severity that unskilled performance of
the following procedures would be hazardous and the patient's condition results
from severe circulatory embarrassment or an area of desensitization in a leg or
foot, payment shall be made for routine foot care, including the cutting or
removing of a:
2. Callus; or
(2) A service
ordinarily considered routine shall be covered if the service is performed as a
necessary and integral part of an otherwise covered service, including the
diagnosis or treatment of:
(a) A diabetic
(b) A wound; or
(c) An infection.
(3) A diagnostic or
treatment service for a foot infection shall be covered.
Incorporation by Reference. (1) "Podiatry Program Manual", July 1997
edition, Department of Medicaid Services, is incorporated by reference.
(2) It may be
inspected, copied, or obtained at the Department for Medicaid Services, 275
East Main Street, Frankfort, Kentucky, 40621, Monday through Friday, 8 a.m. to
4:30 p.m. (Recodified from 904 KAR 1:270, 5-2-86; Am. 18 Ky.R. 1647; eff.
1-10-92; 23 Ky.R. 4241; 24 Ky.R. 385; eff. 7-16-97.)