CMS Pub. 100-03, ch. 1, § 70.2

Nursing Facility

(Rev. 1, 10-03-03)

CIM 50-8

Consultation services rendered by a podiatrist in a skilled nursing facility are covered if

the services are reasonable and necessary and do not come within any of the specific

statutory exclusions. Section 1862(a)(13) of the Act excludes payment for the treatment

of flat foot conditions, the treatment of subluxations of the foot, and routine foot care. To

determine whether the consultation comes within the foot care exclusions, apply the same

rule as for initial diagnostic examinations, i.e., where services are performed in

connection with specific symptoms or complaints which suggest the need for, covered

services, the services are covered regardless of the resulting diagnosis. The exclusion of

routine physician examinations is also pertinent and would generally exclude podiatric

consultation performed on all patients in a skilled nursing facility on a routine basis for

screening purposes, except in those cases where a specific foot ailment is involved.

Section 1862(a)(7) of the Act excludes payment for routine physical checkups. (See the

Medicare Benefit Policy Manual, Chapter 16, “General Exclusions from Coverage,” §90

and §100.)