Dogged Determination by CPMA Results in DHCS Clarifications and Codification of Medi-Cal Reimbursement for Podiatry Services Rendered by DPMs

 

In 2014 the California Podiatric Medical Association (CPMA) introduced AB 1868 to restore adult podiatric services to Medi-Cal. During the legislative process, the Department of Health Care Services (DHCS) became aware of the fact that podiatric physicians were providing services to Medi-Cal beneficiaries in the ER and other inpatient settings without reimbursement.

Late summer of 2015, after months of discussion, DHCS informed CPMA that it would make administrative changes to its policy to allow podiatric services to be reimbursed by Medi-Cal when rendered in emergency room settings (including outpatient and inpatient) and qualifying clinics. Despite assurances that the new policies would take effective immediately, CPMA continued to receive calls from members regarding non-payment for services rendered in the ER and qualifying clinics and asking how to bill for those services. Members also reported that when they contacted Medi-Cal they would be told by the agent with whom they spoke that they were not aware of any change in policy.

CPMA continued to press DHCS on the issue, and in this past January DHCS released updates to its provider manuals regarding reimbursement of podiatric services.

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