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<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.15.05" title_num="10" subtitle_num="09" chapter_num="15" heading="Limitations.">
  <paragraph num="A.">
    <text>The Program does not cover the following under this chapter:</text>
    <paragraph num="(1)">
      <text>Services which are not medically necessary;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Investigational or experimental drugs or procedures;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Services prohibited by the Maryland Podiatry Act or the State Board of Podiatric Medical Examiners;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Services denied by Medicare as not medically justified;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Drugs and supplies which are acquired by the podiatrist at no cost;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Injections and visits solely for the administration of injections, unless medical necessity and the patient's inability to take oral medications are documented in the patient's medical record;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>More than one visit per day unless adequately documented in the patient's medical record as an emergency;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Visits by or to the podiatrist solely for the purpose of the following:</text>
      <paragraph num="(a)">
        <text>Prescription or drug pick-up;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Collection of specimens for laboratory procedures, except by venipuncture, capillary or arterial puncture; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Interpretation of laboratory tests or panels;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>Physical therapy;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Orthotics and inlays of any type and related services;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Disposable medical supplies;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Administration of anesthesia as a separate charge;</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Personal hygiene care;</text>
    </paragraph>
    <paragraph num="(14)">
      <text>Routine care, except visits for participants who are diabetic or who have a vascular disease affecting the lower extremities;</text>
    </paragraph>
    <paragraph num="(15)">
      <text>Non-surgical hospital visits;</text>
    </paragraph>
    <paragraph num="(16)">
      <text>Laboratory or X-ray services not performed by the provider or under the direct supervision of the provider; and</text>
    </paragraph>
    <paragraph num="(17)">
      <text>Podiatric inpatient hospital services rendered during an admission denied by the utilization control agent or during a period that is in excess of the length of stay authorized by the utilization control agent.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Routine podiatric care is limited to one visit every 60 days for participants who have diabetes or peripheral vascular diseases that affect the lower extremities when rendered in the podiatrist's office, the participant’s home, or a nursing facility.</text>
  </paragraph>
  <paragraph num="C.">
    <text>A licensed podiatrist shall perform in a licensed hospital or ambulatory surgical center, subject to the provisions of Health-General Article, §19-351, Annotated Code of Maryland, all surgical procedures of the ankle below the level of the dermis, arthrodeses of two or more tarsal bones, and complete tarsal osteotomies. A licensed podiatrist who performs these procedures in an ambulatory surgical center shall:</text>
    <paragraph num="(1)">
      <text>Have current privileges at a licensed hospital for the same procedures; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Meet the requirements of the ambulatory surgical center.</text>
    </paragraph>
  </paragraph>
</regulation>