Clarifying The Best Way To Satisfy Medicare’s ‘Date Last Seen’ Requirement

Most routine foot care coverage policies provide a list of qualifying systemic diagnoses. An asterisk accompanies some of the diagnoses on those lists. The asterisk indicates that the patient needs to have seen the provider who is treating or in some cases, has diagnosed, the condition with an asterisk within a certain period of time from the date that one performs routine foot care.

What provider type that treating or diagnosing provider may be differs based on the payer. Some payers insist that provider only be a MD or DO. Other payers allow the provider to be a MD, DO or a non-physician practitioner (NPP). Non-physician practitioner usually refers to a physician assistant or a nurse practitioner. The majority of patients who qualify for routine foot care coverage have Medicare medical insurance. While Medicare is a national program, Medicare Administrative Contractors (MACs) administer this program on a local level.  

With this in mind, I have listed provider type allowances below for each of the seven MACs.

First Coast Services (FL, PR, VI)

Provider diagnosing the condition with an asterisk can be a MD, DO or NPP. 

Palmetto GBA (AL, GA, TN, SC, VA, WV, NC)

Provider documenting the condition with an asterisk can be a MD, DO or NPP. 

Noridian Healthcare Solutions, LLC (AK, ID, OR, WA, AZ, MT, ND, SD, UT, WY, CA, HI, NV)

Provider diagnosing the condition with an asterisk must be a MD or DO. 

Novitas Solutions, Inc. (CO, NM, OK, TX, AR, LA, MS, DE, Washington DC, MD, NJ, PA)

Provider actively caring for the condition with an asterisk can be a MD, DO, or NPP. 

NGS, Inc (IL, MN, WI, CT, NY, ME, MA, NH, RI, VT)

Provider actively caring for the condition with an asterisk can be a MD, DO or NPP. 

CGS Administrators, LLC (KY, OH)

Provider actively caring for the condition with an asterisk can be a MD, DO or NPP. 

WPS Ins Corp (IA, KS, MO, NE, IN, MI)

Provider actively caring for the condition with an asterisk must be a MD or DO. 

These are only the MACs. Other payers may have different guidelines. Always check with each individual payer regarding its guidelines as they may differ from the MAC guidelines provided for the same state. 

Dr. Lehrman operates Lehrman Consulting, LLC, is a consultant to the APMA Health Policy and Practice Department, serves as an expert panelist on Codingline, and is a Certified Professional Coder. Follow him on Twitter @DrLehrman