When is the treatment of mycotic nails considered routine and not covered for an ambulatory patient?
Any treatment of a fungal (mycotic) infection of the toenail for an ambulatory patient is considered routine and not covered in the absence of the documentation by the physician attending the patient’s mycotic condition of the (1) clinical evidence of mycosis of the toenail, and (2) the patient has marked limitation of ambulation, pain, or secondary infection resulting from the thickening and dystrophy of the infected toenail plate.
Related Questions
- If an out of state patient covered by a Texas plan receives treatment from an out of state provider, will the Texas prompt pay rules apply?
- When is the treatment of mycotic nails considered routine and not covered for an ambulatory patient?
- When is the treatment of mycotic nails for nonambulatory patients covered?
