1. 2018 IHCP Workgroups
Podiatry
HHW-HIPP0552(3/18)

2. Provider Requirements Program Coverage
Agenda
Provider Requirements
Program Coverage
Hoosier Healthwise Package A
Hoosier Healthwise Package C
Healthy Indiana Plan
Code Sets
Claim Requirements
Reimbursement

3. Provider Requirements
Podiatry is a self-referral specialty
To provide services to members, providers must be:
An IHCP provider
Qualified to render podiatry services
Enrolled with a specialty 140 (podiatrist)
Practicing within the scope of his or her medical license

4. Program Coverage Hoosier Healthwise Package A
Hoosier Healthwise Coverage
Podiatry is a self-referral service, however, for routine foot care services, all IHCP members are subject to the restrictions described in the Routine Foot Care section of the IHCP Podiatry Module.
Hoosier Healthwise Package A covers:
Surgical procedures involving the foot
Laboratory or X-ray services
Hospital stays when medically necessary
No more than six routine foot care visits per year
Out-of-State podiatric services
Limitations are the same as instate services

5. Program Coverage Hoosier Healthwise Package C
Hoosier Healthwise Package C covers:
Surgical procedures involving the foot
Laboratory or X-ray services
Hospital stays when medically necessary
Out-of-State podiatric services
Coverage is subject to any limitations included in the CHIP benefit package
Routine foot care services are not covered

6. Program Coverage Healthy Indiana Plan
Healthy Indiana Plan Coverage
Self-referral within the MDwise network
HIP Podiatry services are available for:
HIP State Basic
HIP State Plus
HIP coverage only available for individuals with lower extremity circulatory disorders including diabetes

7. Code Sets
Podiatry services are reimbursed based on the Podiatry Service Codes provided by IHCP
Code Sets: services/billing-and-remittance/code-sets.aspx
Table 1 – Covered Procedure Codes for Podiatrists (Specialty 140)
Table 2 – Procedure Codes for Routine Foot Care
Table 3 – ICD-10 Diagnosis Codes for Routine Foot Care Coverage
Table 4 – Procedure Codes for Therapeutic Shoes for Severe Diabetic Foot Disease

8. Submission Guidelines:
Claim Requirements
Submission Guidelines:
Claim submission within 90 days of date of service for
in-network providers
Claim submission within 365 days of date of service for
out-of-network providers
MDwise Quick Contact Guide
Claims will be adjudicated within:
21 calendar days for clean electric claim submissions
30 calendar days for clean paper claim submissions

9. Hoosier Healthwise Healthy Indiana Plan Reimbursement
Claims are reimbursed based on Medicaid rates
IndianaMedicaid.com
Healthy Indiana Plan
Claims are reimbursed based on Medicare rates
If a Medicare rate is not available, services will be reimbursed at 130% of the Medicaid rate
CMS.gov

10. IHCP Provider Modules Resources Indianamedicaid.com Code Sets
MDwise Provider Manual
MDwise Prior Authorization

11. Questions