Orthotics/Prosthetics Services Billed by Podiatrist

Date: February 9, 2023
 
Attention: Podiatrist Providers

Effective date: May 9, 2023

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Beginning May 9, 2023 and in accordance with Texas Medicaid reimbursement guidelines, TCHP will no longer reimburse podiatry providers for orthotic/prosthetic services. This reimbursement policy aligns with criteria available in the most recent Texas Medicaid Provider Procedures Manual (TMPPM).

Reference: See Sec 2.2.19 Orthotic Services (CCP) (services are a Medicaid benefit when provided by a licensed orthotist or licensed prosthetist/orthotist; certain devices may be provided by a Medicaid-enrolled DME vendor).  See Section 2.2.20 (Prosthetic Services) (services are a Medicaid benefit when provided by a licensed prosthetist or licensed prosthetist/orthotist).

TCHP has historically reimbursed podiatrists for these services and will revert to the TMPPM reimbursement methodology effective 90 days from the date of this notice.

How this impacts providers: This provider alert is intended to provide 90 days advance notice to podiatry providers of upcoming changes to reimbursement for orthotic and prosthetic services. Providers should follow the reimbursement policies outlined in the Texas Medicaid Provider Procedures Manual.

Next steps for providers: Podiatry providers may prescribe orthotic devices (for conditions of ankle and foot only), but prosthetic devices must be prescribed by a physician.  Prostheses must be dispensed, fabricated, or modified by a licensed prosthetist or prosthetist/orthotist enrolled in Medicare and CCP.  Podiatry providers should order and/or refer to licensed orthotists, prosthetists/orthotists, or orthotic/prosthetic durable medical equipment (DME) suppliers, as applicable, for TCHP members requiring these types of medically necessary medical supplies. 

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.