Individual Consideration

(A) Some services listed in Subchapter 6 of the Podiatrist Manual are designated "I.C.," an abbreviation for individual consideration. Individual consideration means that a fee could not be established. Payment for an individual-consideration service is determined by the MassHealth agency's professional advisors based on the podiatrist's descriptive report of the service furnished. (B) To receive payment for an individual-consideration service, the podiatrist must submit with the claim a report that contains the diagnosis, a description of the condition of the foot, and the length of time spent with the member. (C) Determination of the appropriate payment for an individual consideration service is in accordance with the following criteria: (1) the amount of time required to perform the service; (2) the degree of skill required to perform the service; (3) the severity and complexity of the member's disease, disorder, or disability; (4) the policies, procedures, and practices of other third-party insurers, both governmental and private; (5) prevailing professional ethics and accepted customs of the podiatric community; and (6) such other standards and criteria as may be adopted from time to time by DHCFP or the Division. (D) For shoes and corrective devices see 130 CMR 442.421 and 442.422.