Podiatry Services

For Members

• Podiatrists are healthcare providers who are specialized in the diagnosis and the treatment of disorders of the foot, ankle and leg (lower limb). They can prevent and correct deformities, relieve pain and treat infections of the lower limbs.

• Chronic conditions like diabetes, peripheral arterial disease and rheumatoid arthritis might require foot care services.

• Many services are rendered by Podiatrists but the most common services covered by insurance plans (but not limited to) are:
  • Diabetic foot.
  • Thick callouses or corns
  • An ingrown toenail
  • A persistent fungal infection in the skin or nails
  • Verruca
  • Bunions

• Referral from physicians will be required, if podiatry services are not mentioned in Table of Benefits/Exclusions of your policy; it shall be analyzed according to the medical necessity.

• If the insurance policy is covering podiatry services under alternative treatment, then referral from Physician is not required.

• Referral from physician is required 1 time per case/condition (multiple sessions/procedures for the same condition do not require multiple referrals).

• Podiatry services related to cosmetic reasons (not medically necessary) will not be approved.

 For Healthcare Providers

• All types of Podiatry Services require Pre-Authorization from Nextcare.
• Podiatry services are covered for all plans if medically necessary, not experimental/ investigational, and within the anatomic region of foot-ankle-below knee (proximal extremity of the lower limb).
• The following services may be billed by Podiatrists as ordering and performing clinician:
  • Routine Foot Care (in case the member is suffering from a medical conditions)
  • Surgical Foot Care (post-surgical foot care)
  • Diabetic foot care.
  • Management with prosthetics/ orthotics

• Services performed by Podiatrists at the following anatomical locations will not be covered:
  • Hand
  • Knee and above-knee
  • Unspecified locations

Rejection reason:

• In case of rejection, the rejection reasons for Podiatry Services will be:
  • NCOV-003: Benefit not covered for the member