| Is the Benefit Covered? |
Copayment Requirement |
Prior Approval Requirement |
Coverage Limitations |
Reimbursement Methodology |
Populations Covered |
|
|
Alabama
|
|
No
|
|
|
|
|
|
|
Alaska
|
|
No
|
|
|
|
|
|
|
Arizona
|
|
Yes
|
|
Yes
|
Routine foot care covered only for specified systemic conditions and limited to 2 visits/3 months
|
Fee for service
|
CN & MN
|
|
Arkansas
|
|
Yes
|
|
|
2 visits/year
|
Fee for service, lab services reimbursed up to Medicare payment ceilings
|
CN & MN
|
|
California
|
|
Yes
|
$1/visit
|
Specified services including any services for nursing facility residents
|
Limitations vary by type of service
|
Fee for service
|
CN & MN
|
|
Colorado
|
|
Yes
|
$2/visit
|
|
|
Fee for service
|
CN
|
|
Connecticut
|
|
No
|
|
|
|
|
|
|
Delaware
|
|
Yes
|
|
|
Diagnostic and surgical procedures only, except routine foot care covered only for specified systemic conditions
|
Fee for service
|
CN
|
|
District of Columbia
|
|
Yes
|
|
Specified services
|
|
Fee for service using Medicare upper limits
|
CN & MN
|
|
Florida
|
|
Yes
|
$2/day
|
|
Visit frequency limitations based on site of service, routine foot care covered only for specified systemic conditions
|
Fee for service
|
CN & MN
|
|
Georgia
|
|
Yes
|
$.50-$3 for selected services dependng on payment rate
|
Specified services including most services for nursing facility residents
|
12 visits/year, specified services not covered
|
Fee for service, services performed in outpatient hospital rather than office paid lower fees
|
CN & MN
|
|
Hawaii
|
|
Yes
|
|
Inpatient hospital services and appliances costing more than $100
|
Routine foot care and other specified services not covered
|
Fee for service
|
CN & MN
|
|
Idaho
|
|
Yes
|
|
|
Routine foot care and other specified services not covered
|
Fee for service
|
CN
|
|
Illinois
|
|
Yes
|
$2/visit
|
Specified services or unusual procedures
|
|
Fee for service
|
CN & MN
|
|
Indiana
|
|
Yes
|
|
Inpatient hospital services and specified services associated with orthopedic shoes and appliances
|
Routine foot care covered only for specified systemic conditions at 6 visits/year, second opinion required for specified services
|
Fee for service
|
CN
|
|
Iowa
|
|
Yes
|
$1/day
|
Specified services
|
Specified services and appliances not covered
|
Fee for service
|
CN & MN
|
|
Kansas
|
|
Yes
|
|
|
12 office visits/year included in physician limit
|
Fee for service
|
CN & MN
|
|
Kentucky
|
|
Yes
|
A, C & D - $2/visit
|
|
Specified services, orthopedic shoes and appliances not covered
|
Fee for service with upper limits set at 65% of median billed charge for ambulatory services and at 50% of median for services in inpatient hospital setting
|
A, B, C & D - See state-specific FN
|
|
Louisiana
|
|
Yes
|
|
Specified surgical procedures
|
12 visits/year,1 inpatient hospital visit/day, specified services not covered
|
Fee for service
|
CN & MN
|
|
Maine
|
|
Yes
|
$.50-$2/day, depending on payment, up to $20/month
|
Specified procedures and services
|
Routine foot care covered only for specified systemic conditions
|
Fee for service
|
CN & MN
|
|
Maryland
|
|
Yes
|
|
|
1 chronic care visit/2 months, routine foot care covered only for specified systemic conditions
|
Fee for service
|
CN & MN
|
|
Massachusetts
|
|
Yes
|
|
|
Limited to services medically necessary for life and safety
|
Fee for service
|
CN & MN
|
|
Michigan
|
|
Yes
|
$2/visit
|
Selected procedures
|
Routine foot care not covered
|
Fee for service
|
CN & MN
|
|
Minnesota
|
|
Yes
|
$3/visit for non-preventive services
|
|
|
Fee for service
|
A & B - See state-specific FN
|
|
Mississippi
|
|
Yes
|
$3/visit
|
|
12 visits/year included in physician visit limit, routine foot care covered only for specified systemic conditions
|
Fee for service using a percentage of Medicare allowable payment as ceiling
|
CN
|
|
Missouri
|
|
Yes
|
$.50-$3/service, depending on payment
|
|
Specified services are no longer covered for adults who are not pregnant, blind or residing in nursing facilities
|
Fee for service
|
CN & MN
|
|
Montana
|
|
Yes
|
$4/visit
|
|
|
Fee for service
|
A & B - See state-specific FN
|
|
Nebraska
|
|
Yes
|
$1/visit
|
|
1 routine foot care visit/3 months for non-ambulatory patients and 1 visit/month for ambulatory
|
Fee for service
|
CN & MN
|
|
Nevada
|
|
No
|
|
|
|
|
|
|
New Hampshire
|
|
Yes
|
|
|
12 visits/year, routine foot care covered only for specified systemic conditions
|
Fee for service
|
CN & MN
|
|
New Jersey
|
|
Yes
|
|
Post-fracture or surgical care, orthopedic shoes and appliances
|
Routine foot care covered only for specified systemic conditions, 1 debridement of toenails/2 months, treatment of flat feet and subluxations not covered
|
Fee for service
|
CN & MN - See state-specific FN
|
|
New Mexico
|
|
Yes
|
A - $5/visit, B - $7/visit - see state-specific FN
|
Specified services including routine foot care
|
Coverage parameters follow Medicare criteria
|
Fee for service, some services performed in hospital setting paid 60% of fee
|
CN
|
|
New York
|
|
No
|
|
|
|
|
|
|
North Carolina
|
|
Yes
|
$3/visit
|
|
8 visits/year included in limits with other specified practitioners - limits set annually by the legislature
|
Fee for service
|
CN & MN
|
|
North Dakota
|
|
Yes
|
$3/visit
|
|
|
Fee for service
|
CN & MN
|
|
Ohio
|
|
Yes
|
|
Specified services
|
24 visits/year that count toward physician visit limit
|
Fee for service
|
CN
|
|
Oklahoma
|
|
Yes
|
$1/service
|
|
4 non-emergency ambulatory visits/month included in physician limit, routine foot care covered only for specified systemic conditions
|
Fee for service
|
CN
|
|
Oregon
|
|
Yes
|
A - $3/visit
|
Specified services and appliances
|
Second opinion required for specified services, routine foot care not covered
|
Fee for service, second and subsequent surgical procedures same session paid 50% of fee or less, drugs, supplies and appliances paid cost
|
A - See state-specific FN
|
|
Pennsylvania
|
|
Yes
|
$.50-$3/service, depending on payment rate
|
|
Frequency limits vary by service; routine foot care, physical therapy, orthopedic shoes and appliances not covered
|
Fee for service
|
CN & MN
|
|
Rhode Island
|
|
Yes
|
|
Specified services and appliances
|
|
Fee for service
|
CN - see state-specific FN
|
|
South Carolina
|
|
Yes
|
$1/visit
|
|
12 visits/year, visits count toward physician visit limit
|
Fee for service
|
CN
|
|
South Dakota
|
|
Yes
|
$2/procedure
|
|
Routine foot care and treatment of flat feet not covered
|
Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures, supplies paid 90% of charge
|
CN
|
|
Tennessee
|
|
Yes
|
B1 - $5/visit, B2 - $10/visit
|
|
|
|
A & B - See state-specific FN
|
|
Texas
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Utah
|
|
Yes
|
$3/visit
|
|
A & B - Coverage limited to specified procedures, routine foot care not covered, C - Limited to medically essential procedures only
|
Fee for service, second and subsequent surgical procedures same session paid 50% of fee or less, rural providers may be paid higher fees
|
A, B & C - See state-specific FN
|
|
Vermont
|
|
Yes
|
|
|
Routine foot care not covered
|
Fee for service
|
A & B - See state-specific FN
|
|
Virginia
|
|
Yes
|
$1/visit
|
Specified services
|
Preventive and routine foot care not covered
|
Fee for service
|
CN & MN
|
|
Washington
|
|
Yes
|
|
|
Routine foot care not covered
|
Fee for service
|
CN & MN
|
|
West Virginia
|
|
Yes
|
|
Specified services and appliances
|
|
Fee for service
|
B
|
|
Wisconsin
|
|
Yes
|
$.50-$3, depending on service, maximum $30/year/provider
|
Electric bone stimulation
|
1 routine foot care visit/61 days for specified systemic conditions, specified services not covered including treatment of flat feet
|
Fee for service
|
CN & MN
|
|
Wyoming
|
|
No
|
|
|
|
|
|
|
American Samoa
|
|
No
|
|
|
|
|
|
|
Guam
|
|
Yes
|
|
|
Routine foot care not covered
|
Fee for service
|
CN
|
|
Northern Mariana Islands
|
|
No
|
|
|
|
|
|
|
Puerto Rico
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Virgin Islands
|
|
Yes
|
|
|
|
Fee for service
|
CN
|
