Podiatry is Kentucky Medicaid Provider Type (80) for individual providers and type 809& for group providers. To bill Kentucky Medicaid, podiatry providers must be:
- enrolled in Medicare
- licensed in Kentucky
- enrolled as a Kentucky Medicaid provider
- enrolled with the managed care organization of any beneficiary it serves.
What are Podiatry Services
- Payment will be made for routine foot care if:
- The patient has a systematic disease of sufficient severity such as arteriosclerosis, chronic thrombophlebitis, diabetes or a peripheral neuropathy;
- Unskilled performance of a procedure per paragraph (b) of 907 KAR 1:270, Section 3. would be hazardous; and
- The patient's condition results from:
- Severe circulatory embarrassment or
- An area of desensitization in a leg or foot.
- Routine foot care covered under this subsection includes the cutting or removing of:
- A service ordinarily considered routine is covered if the service is performed as a necessary and integral part of an otherwise covered service, including the diagnosis or treatment of:
- A diabetic ulcer;
- A wound; or
- An infection.
- Diagnostic or treatment service for a foot infection is covered.
Podiatry providers must meet the coverage provisions and requirements of 907 KAR 1:270. Services must be performed within the scope of practice for any provider. Listing of services in an administrative regulation is not a guarantee of payment. Providers must follow all relevant state Medicaid regulations. All services must be medically necessary.
Podiatry services are reimbursed per
907 KAR 1:280.
Duplication of Service
The department does not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered during the same time period.
Podiatry services requiring prior authorization must contact CareWise.
Kentucky Medicaid currently contracts with Gainwell Technologies to process Medicaid fee-for-service claims. Each MCO processes its own claims.
Kentucky Medicaid uses the National Correct Coding Initiative edits and the McKesson Claim Check System to verify incidental or mutually exclusive codes. Kentucky Medicaid also uses Correct Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. Kentucky Medicaid requires the use of CMS 1500 billing forms. Providers must bill Kentucky Medicaid using the correct CPT codes.
Appeal requests made on denied fee-for-service claims must be submitted to Gainwell Technologies and include the reason for the request along with a hard copy claim. Please refer to the MCO if appealing an MCO claim.
Claims must be received the longer of either 12 months from the date of service or six months from the Medicare pay date or within 12 months of the last Kentucky Medicaid denial.
Provider Contact Information
If you can't find the information you need or have additional questions, please direct your inquiries to:
Billing Questions - Gainwell Technologies - (800) 807-1232
Provider Questions - (855) 824-5615
Prior Authorization - CareWise - (800) 292-2392
Provider Enrollment or Revalidation - (877) 838-5085
KyHealth.net assistance - Gainwell Technologies - (800) 205-4696
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drug (PAD) List - Pharmacy Branch - (502) 564-6890