67:16:07:04Services not covered.

The following podiatry services are not covered under the medical assistance program: (1) Stock orthopedic shoes, unless covered under chapter 67:16:11 for children less than twenty-one years of age, or built into a leg brace; (2) The treatment of flatfoot; (3) Surgical or nonsurgical treatment of subluxations of the foot, undertaken for the sole purpose of correcting a subluxated structure in the foot as an isolated entity, but not including: (a) Surgical correction of a subluxated foot structure that is an integral part of the treatment of a foot injury; or (b) Surgical correction of a subluxated foot structure that is undertaken to improve the function of the foot or to alleviate an inducted or associated symptomatic condition; (4) Routine foot care, unless infected or eczematized, or the individual has been diagnosed with metabolic, neurologic, or peripheral vascular disease: (a) Cutting or removing corns or calluses; (b) Trimming nails; (c) Hygienic and preventive maintenance care; (d) Using skin creams to maintain the skin tone of ambulatory and bedfast patients; and (e) The provision of services in the absence of localized illness, injury, or symptoms involving the foot; and (5) Treatment of a fungal infection of the toenail, unless there is clinical evidence of mycosis of the toenail and medical evidence documenting that: (a) The patient has a marked limitation of ambulation requiring active treatment of the foot; or (b) The patient is nonambulatory and has a condition that is likely to result in significant medical complication in the absence of treatment.

Source: 1 SDR 30, effective October 13, 1974; repealed, 3 SDR 26, effective October 6, 1976; readopted, 16 SDR 114, effective January 15, 1990; 16 SDR 227, effective June 25, 1990; 33 SDR 125, effective January 31, 2007; 44 SDR 94, effective December 4, 2017; 46 SDR 50, effective October 10, 2019; 49 SDR 21, effective September 12, 2022; 50 SDR 63, effective November 27, 2023.