- Participating Physician Groups (PPG)
Health Net Medicare Advantage (MA) HMO plans cover Medicare-covered podiatry services if determined to be medically necessary by the member's participating physician group (PPG) or Health Net.
Routine podiatry care must be coordinated through the primary care physician (PCP), unless otherwise designated by the PPG, and is limited to one visit per calendar month. This provides coverage for members who cannot adequately give themselves routine foot care. An example of covered routine foot care is toenail trimming for a member with an arthritic condition of the hands who is not able to perform the task. Routine foot care is covered, as deemed necessary by the PCP. Additionally, although the routine foot care benefit is limited to one visit per calendar month, the PCP should determine the frequency of visits. In some instances, the member may need routine podiatry care less frequently.
Routine podiatry services are the following:
- Cutting or removal of corns or calluses
- Trimming, cutting, clipping, or debridement of nails
- Other hygienic preventive maintenance care in the realm of self-care for both ambulatory and bed confined members
If the PCP does not perform the routine podiatry services, the PPG must refer the member to a licensed practitioner that does. Members are required to obtain a referral from the PCP for up to six visits or as specified by the PPG.
In addition, routine podiatry services are covered for Health Net MA members who are institutionalized in a nursing home or convalescent home, regardless of their medical diagnosis. Such routine podiatry care must be ordered by the PCP and is limited to one visit per calendar month. These visits are subject to scheduled copayments.