HI 00620.190 Application of Foot Care Exclusion to Physicians' Services

In evaluating claims for physicians' services against the foot care exclusions, carriers exclude charges for any services in connection with noncovered foot care unless such services are performed only incidentally to, at the same time as, and as a necessary integral part of a primary covered procedure. The only exception to this rule will apply where diagnostic services or procedures are performed in connection with a specific symptom or complaint; in such situations, payment may be made for the initial diagnostic services regardless of the resulting diagnosis.

If an itemized bill reports both covered services and noncovered services not integrally related to the covered services, the portion of charges attributable to the noncovered services will be denied. If however, the primary procedure reported on a bill is a covered service and it is clear that all services performed were directly related to the primary procedure, the physician's total performance on such occasions, including any incidental otherwise noncovered services, is covered. Where an excluded service is the primary procedure involved, it is not covered regardless of its complexity or difficulty. The coverage or exclusion of any given foot treatment depends on the nature of the services and not on whether it was performed by a podiatrist, osteopath or doctor of medicine. Whether administration of anesthesia is covered depends on whether the primary procedure being performed by the physician is itself covered.