Out-of-Office Visits

The MassHealth agency pays for podiatric care provided in a hospital, a member's home, or a long-term-care facility only when the following conditions are met. (A) Podiatric care provided in any of the above settings is designed to treat a diagnosed condition, to minimize bed confinement, and to increase the member's activity. (B) The podiatrist performs and documents a complete evaluation and all necessary treatment for relief of the member's symptoms or for the diagnosed condition. (C) If further treatment is required, the podiatrist formulates a treatment plan and includes it in the member's medical record. This plan must justify any further diagnostic procedures, additional treatment, return visits, or referrals and must include the following information: (1) a diagnosis of the member's podiatric condition; (2) results of X rays and other diagnostic tests, if performed; and (3) a description of treatment provided and recommendations for additional treatment. (D) The treatment plan is updated after each visit and details the member's progress. (E) Documentation of all out-of-office visits, including the member's evaluation, progress, and treatment plan, must be kept either in the podiatrist's office or at the appropriate facility where the service is provided. (F) Payment is limited to one out-of-office visit per member in a 30-day period in a long-term-care facility or the member's home and two visits in a 30-day period for a member in a hospital setting. (G) The MassHealth agency pays for either a visit or a treatment procedure. The MassHealth agency does not pay for both a visit and a treatment or surgical procedure provided to a member on the same day in the same location.