[Provider] Podiatry Terms - Clarification

[Provider Notification]

 Guidance for Podiatry Terms 

 

Several providers asked MaineCare to clarify the terms used in the podiatry rules.  In response, MaineCare clinical staff offers the following.  

 

Interpretation of the term "loss of function" and "risk (of) loss of limb" varies from case to case and requires clinical interpretation.  The following guidelines must be used in that interpretation: 

1)       The loss of function or threat of loss of limb must be substantial.  Conditions such as diabetes, peripheral vascular disease, or chronic venous insufficiency must be considered in considering that loss of function or threat of loss of limb. 

2)       Other factors to consider include: 

§         Loss or substantial threat to the ability to ambulate effectively 

§         Loss or substantial threat to the ability to work 

§         Substantial risk of new or worsening systemic disease as a result of the condition 

§         Recurrent or persistent skin ulceration. 

 

Questions about podiatry services and prior authorization can be directed to Schaller Anderson at 1-866-543-2387.  Schaller Anderson handles MaineCare's prior authorizations for podiatry services.   More information is also available at MaineCare's Prior Authorization website <http://www.maine.gov/dhhs/bms/providerfiles/pa_inst_sheets_forms.html#podiatry> .   

 

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This is a one-way communication.  Do not reply to this e-mail.  Your e-mail will not receive response.  If you have questions, please call 1-800-321-5557.  

 

 

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