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Texas State Board of
Podiatric Medical Examiners

Physical Address: 333 Guadalupe, Suite #2-320; Austin, Texas 78701
Mailing Address: P.O. Box 12216; Austin, Texas 78711
Phone: (512)-305-7000
Facsimile: (512)-305-7003
www.tsbpme.texas.gov

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Questions & Answers

The following information is made available (Texas Government Code §2001.007) by the Texas State Board of Podiatric Medical Examiners as guidance (resource). If the public or licensees have any question or confusion about the interpretation of the information or for further scope of practice inquiries, please contact the Board's Executive Director at Hemant.Makan@tsbpme.texas.gov to submit a written request. Response times can vary (with associated delays) due to staffing levels/budgetary constraints, pending priorities, the nature of the request, need for further staff review and/or review by the full Board at the next regularly scheduled Board Meeting.

Unless otherwise specifically cited, this information by the Texas State Board of Podiatric Medical Examiners is not intended to supersede the authority of any other regulatory board or entity that may have jurisdiction on these issues. Additionally, this information is not intended to be construed as a "Rule" under the Administrative Procedure Act or otherwise. Furthermore, this information is not a formal legal opinion nor advisory opinion, which this Board does not issue.

  1. What is a Podiatrist’s scope of practice in Texas? What specific procedures can a Podiatrist perform?
  2. Are Board Actions reportable to the National Practitioner Data Bank (NPDB)?
  3. What is the penalty for practicing Podiatric Medicine without a license?
  4. Do Podiatrists write prescriptions?
  5. Do Podiatrists conduct “History & Physicals” ... and make "Hospital Admissions"? What about "Federal Motor Carrier Safety Administration (FMCSA) DOT Medical Exams & Commercial Motor Vehicle Certifications"? What about "University Interscholastic League (UIL) Pre-Participation Physical Evaluations - Physical Examinations"?
  6. For regulatory and compliance purposes, what portions of the Board Statute and Rules should Podiatrists make sure they know?
  7. What does it mean if a Podiatrist’s license is in a “Delinquent” or "Cancelled" status; can they still practice?
  8. Do Podiatrists sign the written statement that accompanies the application for Disabled Person Placards and License Plates?
  9. Can Podiatrists use the word "Ankle" in an advertisement?
  10. Where can I find information to allow me (a Podiatrist) to prescribe Durable Medical Equipment (DME)? Also, can I own/operate a "Shoe Store" as part of my podiatry practice?
  11. I'm "Retiring"! What do I need to do in order to properly close my practice? What about practice/group departures?
  12. I am a prospective patient, what can I do to research the background of a podiatrist or healthcare provider?
  13. I am a Podiatrist who would like to include Hyperbaric Oxygen (HBO) therapy as part of my Wound Care treatments. What are the requirements, scope and regulations for me to perform HBO? What else should I know?
  14. I am a Podiatrist who is the subject of a complaint investigation filed by one of my patients. Is it o.k. for me to contact the patient to discuss his/her complaint while the Board investigates the matter?
  15. I am a Podiatrist who is having problems with an (private) Insurance Company. I have been denied payment, my payments are not timely and I am having other business problems with the carrier which is having a negative impact on my practice. Who can assist me in filing a complaint to resolve these matters?
  16. Can a Podiatrist order and/or supervise the administering of anesthesia by a CRNA (Certified Registered Nurse Anesthetist)?
  17. I am a patient who has been the victim of a sexual impropriety/act/crime and boundary violation by a physician. Where can I find assistance and information with victims rights beyond solely filing a complaint with the Board or Law Enforcement?
  18. As a patient or podiatric physician, where can I find information related to "Informed Consent Forms"?
  19. I suspect Child Abuse/Neglect/Sexual Exploitation. I also suspect Elder Abuse/Neglect. What do I do?
  20. What are the Medicare regulations relating to Podiatrist orders and debridement of mycotic/dystrophic nail tissue in a nursing home setting? What about "Healthcare Fraud" prevention and creating a "Compliance Program" to prevent the same?
  21. I am a patient with a billing problem. I had seen my doctor who is an out of network provider for my insurance plan. I am now stuck with a large bill for "usual and customary" rates that are not covered and I can't afford this. What can be done?
  22. Can a Podiatrist advertise and promote an off-label non-FDA approved use of lasers (& other drugs/devices) for toenail fungus treatment? Can a Podiatrist provide fingernail fungus (laser) treatment, even upon a prescription from a MD/DO or APN-NP/PA requesting such fingernail treatment?
  23. Can a Podiatrist employ/supervise an Advanced Practice Nurse (APN) or Physician Assistant (PA) and delegate podiatric/medical treatments to an APN/PA (Physician Extenders)?
  24. Can a Podiatrist be a "Medical Director" of a clinic/facility?
  25. Can a Podiatrist be a "Surgical Assistant" for non-podiatry procedures?
  26. Can a Podiatrist administer Nitrous Oxide (N2O) to patients? What about General Anesthesia?
  27. Does a Radiology Technician certification authorize a person to operate (office) lower extremity MRI equipment? Does a Radiology Technician certification authorize a person to operate a mobile fluoroscopic machine such as the Orthoscan Mobile DI?
  28. Health Care Fraud is a nationwide problem of theft from public (Medicare/Medicaid; taxpayer funded) and private health care systems. Where can I learn more about this type of white-collar crime & and it's monetary impact?
  29. Can a Podiatrist sign a "Death Certificate" and "Pronounce Death"?
  30. I am a newly licensed Texas Podiatrist ... where can I get assistance in setting up my new practice?
  31. Where can I get information on what services are covered and not-covered for "Medicare Podiatry Services"?
  32. Can a Podiatrist administer the "Flu Shot"?
  33. Are "Telemedicine & Telehealth" authorized for the practice of Podiatry in Texas?
  1. What is a Podiatrist’s scope of practice in Texas? What specific procedures can a Podiatrist perform?

    Click HERE for scope of practice resource information.

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  2. Are Board Actions reportable to the National Practitioner Data Bank (NPDB)?

    All Board Actions are reportable to the National Practitioner Data Bank (NPDB) as required by Federal Law (in part, TITLE IV OF PUBLIC LAW 99-660; the Health Care Quality Improvement Act of 1986, as amended 42 USC Sec. 11101 01/26/98). What's reportable: "Adverse licensure actions" involving certain disciplinary actions related to "professional competence" or "professional conduct" must be reported for physicians (MD's/DO's) and dentists. "Adverse actions" that must be reported include licensure and certification action. State licensing agencies must report final adverse licensure actions taken against healthcare practitioners. A reportable final adverse licensure action must be a formal or official action; it need not be specifically related to professional competence or conduct. Nevertheless, according to the NPDB, "a settlement agreement which imposes the monitoring of a practitioner for a specified period of time, unless such monitoring constitutes a restriction on the licensee, or is considered to be a reprimand" should not be reported.

    Otherwise, all Board Actions, as a service to the citizens of Texas (Open Record), are published on this website pursuant to Board Rule §376.27(d) which provides: "Licensee's Record. All actions taken by the Board against a licensee shall be made a permanent part of the licensee's record at the Board office reportable on the Board's website and reportable to the NPDB (National Practitioner Data Bank)," and Texas Occupations Code §202.201 “PUBLIC INTEREST INFORMATION” which provides: “(a) The Board shall prepare information of public interest describing the functions of the Board and the Board's procedures by which complaints are filed with and resolved by the Board. (b) The Board shall make the information available to the public and appropriate state agencies.” All T.S.B.P.M.E. investigations resulting in sustained violations of the Podiatric Medical Practice Act of Texas, the Board Rules and any other applicable law are adjudicated via a Board Order/Agreed Order. Those Orders are approved and executed at a Public Meeting, at which time they become a Public/Open Record; Permanent Record (operation of law/rule).

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  3. What is the penalty for practicing Podiatric Medicine without a license?

    Texas Occupations Code Chapter 104 “Healing Art Practitioners” (Title Act) provides for the following:

    Texas Occupations Code §104.001 “Short Title” provides that: “This chapter may be cited as the Healing Art Identification Act.”

    Texas Occupations Code §104.002 “Healing Art” provides that: “The healing art includes any system, treatment, operation, diagnosis, prescription, or practice to ascertain, cure, relieve, adjust, or correct a human disease, injury, or unhealthy or abnormal physical or mental condition.”

    Texas Occupations Code §104.003(a)(g) “Required Identification” provides that: “(a) A person subject to this section who uses the person's name on a written or printed professional identification, including a sign, pamphlet, stationery, or letterhead, or who uses the person's signature as a professional identification shall designate as required by this section the healing art the person is licensed to practice. (g) A person who is licensed by the Texas State Board of Podiatric Medical Examiners shall use: (1) chiropodist; (2) doctor, D.S.C.; (3) doctor of surgical chiropody; (4) D.S.C.; (5) podiatrist; (6) doctor, D.P.M.; (7) doctor of podiatric medicine; or (8)  D.P.M.”

    Texas Occupations Code §104.004 “Other Persons Using Title Doctor” provides that: “In using the title "doctor" as a trade or professional asset or on any manner of professional identification, including a sign, pamphlet, stationery, or letterhead, or as a part of a signature, a person other than a person described by Section 104.003 shall designate the authority under which the title is used or the college or honorary degree that gives rise to the use of the title.”

    Texas Occupations Code §104.005 “Enforcement” provides that: “(a) On the request of a healing art licensing board listed in Section 104.003, the District or County Attorney shall file and prosecute appropriate judicial proceedings in the name of the state against a person who violates Section 104.003. (b) The District or County Attorney shall file the proceeding in the District Court of the County in which the violation occurs.”

    Texas Occupations Code §104.007 “Penalties” provides that: “(a) A person who violates this chapter commits an offense.  An offense under this section is a misdemeanor punishable by: (1)  on conviction of a first offense, a fine of $100; (2) on conviction of a second offense, a fine of $500; and (3) on conviction of a third offense: (A) a fine of $1,000; or (B) revocation of the person's license to practice the healing art. (b) On conviction of the person, the District Court shall notify the licensing board that issued the license.”

    Texas Occupations Code Chapter 202 “Podiatrists” (Practice Act) provides for the following:

    Texas Occupations Code §202.001(a)(3) “Definitions” provides that: “Podiatrist - means a person who: (A)  is licensed under this chapter to practice podiatry and who directly or indirectly charges money or other compensation for podiatric services; or (B) publicly professes or claims to be a podiatrist, foot specialist, or doctor or uses any title, degree, letter, syllable, or word that would lead the public to believe that the person is a practitioner authorized to practice or assume the duties incident to the practice of podiatry.”

    Texas Occupations Code §202.001(a)(4) “Definitions” provides that: “Podiatry - means the treatment of or offer to treat any disease, disorder, physical injury, deformity, or ailment of the human foot by any system or method. The term includes podiatric medicine.”

    Texas Occupations Code §202.251 “License Required” provides that: “A person may not practice podiatry or hold the person out as a podiatrist unless the person is licensed under this chapter.”

    Texas Occupations Code §202.253(a) “Grounds For Denial of License” provides, in part, that: “The Board may refuse to admit a person to an examination, and may refuse to issue a license to practice podiatry to a person, for: (1) presenting to the Board a license, certificate, or diploma that was illegally or fraudulently obtained or engaging in fraud or deception in passing the examination; (4) engaging in grossly unprofessional or dishonorable conduct of a character that in the Board's opinion is likely to deceive or defraud the public; (6) using any advertising statement of a character tending to mislead or deceive the public; (8) purchasing, selling, bartering, or using or offering to purchase, sell, barter, or use a podiatry degree, license, certificate, diploma, or a transcript of a license, certificate, or diploma, in or incident to an application to the Board for a license to practice podiatry; (9) altering, with fraudulent intent, a podiatry license, certificate, diploma, or a transcript of a podiatry license, certificate, or diploma; (10) using a podiatry license, certificate, or diploma, or a transcript of a podiatry license, certificate, or diploma, that has been fraudulently purchased, issued, counterfeited, or materially altered; (11) impersonating, or acting as proxy for, another person in a podiatry license examination; (12)  impersonating a license holder, or permitting another person to use the license holder's license to practice podiatry in this state, to treat or offer to treat, by any method, conditions and ailments of human feet.”

    Texas Occupations Code §202.303 “Practice Without Renewing License” provides that: “A person who practices podiatry without an annual renewal certificate for the current year is considered to be practicing without a license and is subject to all the penalties of the practice of podiatry without a license.”

    Texas Occupations Code §202.601 “Injunction” provides that: “(a)  In addition to any other action, proceeding, or remedy authorized by law, the Board may institute an action in its own name to enjoin the violation of a law regulating the practice of podiatry or a rule adopted under this chapter.  The Court may grant a temporary injunction in the action. (b) The Attorney General or a District or County Attorney shall represent the Board in an action under this section.”

    Texas Occupations Code §202.6015 “Cease and Desist Order” provides that: “(a) If it appears to the Board that a person who is not licensed under this chapter is violating or has violated this chapter, a rule adopted under this chapter, or another state statute or rule relating to the practice of podiatry, the Board after providing to the person notice and the opportunity for a hearing may issue a cease and desist order prohibiting the conduct described in the notice. (b) If the person does not request a hearing before the 22nd day after the date of receiving notice under Subsection (a), the Board may: (1) issue a cease and desist order; and (2) refer the violation to the Attorney General for further action. (c) If the person requests a hearing before the 22nd day after the date of receiving notice under Subsection (a), the Board shall hold the hearing not later than the 30th day after the date the Board receives the request for the hearing. (d) A hearing under this section is subject to Chapter 2001, Government Code. (e) Notwithstanding Section 202.551, the Board may impose an administrative penalty under Subchapter L against a person who violates an order issued under this section.”

    Texas Occupations Code §202.605 “General Criminal Penalty: Practicing Without License” provides that: “(a) A person commits an offense if the person professes to be a podiatrist or practices or assumes the duties incident to the practice of podiatry without holding a license to practice podiatry. (b) An offense under this section is punishable by: (1) a fine of not less than $50 or more than $500;  (2) confinement in the county jail for not less than 30 days or more than six months; or  (3) both the fine and confinement.”  

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  4. Do Podiatrists write prescriptions?

    Note: Visit the Board's "Prescription Information" webpage to obtain additional information on changes to the Texas Prescription Program, Ordering Controlled Substances Prescription Pads, Registering for the New Prescription Drug Monitoring Program Database, Abuse/Misuse of Prescriptions/Pain Medications & Drug Diversion Prevention,  Prescribing Compounded Medications & Health Care Fraud, Controlled Substances Schedule Changes and all other information related to Prescriptions/Controlled Substances. [Posted 08/12/2016 @ 4:52 pm]

    Yes, for a valid medical purpose & within the limits of "Podiatry" scope of practice, Podiatrists can write prescriptions to treat any disease, disorder, physical injury, deformity or ailment of the human foot. A Podiatrist, however, cannot delegate his/her prescriptive authority to any other person.

    In order for an "Actively" licensed (i.e. License No. "####") Podiatric Physician to prescribe Controlled Substances, he/she must have an active Controlled Substances registration from the U.S. Drug Enforcement Administration (DEA) to prescribe "Schedule II, III, IV & V" Controlled Substances. You can learn more about the DEA's jurisdiction and activities by clicking on: DEA Diversion Control Program. You may also view the "Texas Controlled Substances Act" (Texas Health & Safety Code).

    Podiatry Residents enrolled in an accredited GPME residency (training) program who hold a "Temporary" license (i.e. License No. "T##-####") may prescribe Controlled Substances under the (training) facility's DEA registration and remain subject to the supervision of the (training) program and residency director. Under no circumstances are residents allowed to prescribe controlled substances for purposes outside of the approved residency (training) program. Additional DPS information can viewed by clicking "July 7, 2008 Notification of Changes."

    A Federal DEA registration is required to prescribe Controlled Substances and any prescriptive medications including Ibuoprofen 800 mg, topical antifungal creams, oral antibiotics, etc. A podiatrist who does not have a DEA registration cannot prescribe any medications; thus, without a DEA registration a podiatrist cannot provide minimal standards of care. In order to obtain a DEA registration, the podiatrist must first be "Actively" licensed with the Board. 

    Podiatrists writing "Controlled Substances" prescriptions should be on the look-out for "Drug Diversion" & "Doctor-Shopping" patients, and must ensure that they themselves are not diverting controlled substances. Furthermore, all proper medical records must be maintained. The TSBPME recommends that Podiatrists utilize a "Pain Management" Checklist as part of patient treatment and record-keeping to safeguard against "Drug Diversion" & "Doctor-Shopping" patients, and to ensure prescriptions are only for a valid medical purpose.

    All "Controlled Substances" prescriptions are subject, in part, to related U.S. Drug Enforcement Administration, Texas Department of Public Safety and Texas Health & Safety Code provisions. Texas Department of Public Safety - Title 37/Part 1 - Chapter 13 "Controlled Substances" rules can be found HERE.

    Board Rule §375.3 "General" provides that: "(a) The health and safety of patients shall be the first consideration of the podiatric physician. The principal objective to the podiatric profession is to render service to humanity. A podiatric physician shall continually strive to improve his medical knowledge and skill for the benefit of his patients and colleagues. The podiatric physician shall administer to patients in a professional manner and to the best of his ability. Secrets and personal information entrusted to him shall be held inviolate unless disclosure is necessary to protect the welfare of the individual or the community. A podiatric physician shall be temperate in all things in recognition that his knowledge and skill are essential to public health, welfare, and human life. (b) A licensed podiatric physician shall conduct his practice on the highest plane of honesty, integrity, and fair dealing and shall not mislead his patients as to the gravity of such patient's podiatric medical needs. A podiatric physician shall not abandon a patient he has undertaken to treat. He may discontinue treatment after reasonable notice has been given to the patient by the podiatric physician of his intention to discontinue treatment and the patient has had a reasonable time to secure the services of another podiatric physician or all podiatric medical services actually begun have been completed and there is no contract or agreement to provide further treatment."

    Board Rule §375.19 “Fees and Informed Consent” provides that: “(a) The podiatric physician has special knowledge which his patient does not have; therefore, to avoid misunderstanding he should advise his patient in advance of beginning treatment of the nature and extent of the treatment needed; the approximate time required to perform the recommended treatment and services; and any further or additional services or return by the patient for treatment, adjustments, or consultation and the time in which this shall occur. A podiatric physician should inform his patients as to the fees to be charged for services before the services are performed, regardless of whether the fees are charged on a case basis, on the basis of a separate charge for each service, or a combination of these two methods, or some other basis. If an exact fee for a particular service, as in extended care cases, cannot be quoted to a patient, a fair and reasonable estimate of what the fee will be and the basis on which it will be determined should be given the patient. (b) A podiatric physician shall not tender or receive a commission for a referral.”

    Board Rule §375.21(a) "Records" provides that: "All podiatric physicians shall make, maintain, and keep accurate records of the diagnosis made and the treatment performed for and upon each of his or her patients for reference and for protection of the patient for at least five years following the completion of treatment."

    Texas Health & Safety Code §481.067 "Records" provides that: "(a) A person who is registered to manufacture, distribute, analyze, or dispense a controlled substance shall keep records and maintain inventories in compliance with recordkeeping and inventory requirements of federal law and with additional rules the director adopts. (b) The pharmacist-in-charge of a pharmacy shall maintain the records and inventories required by this section. (c) A record required by this section must be made at the time of the transaction that is the basis of the record. A record or inventory required by this section must be kept or maintained for at least two years after the date the record or inventory is made."

    Texas Health & Safety Code §481.071 "Medical Purpose Required Before Prescribing, Dispensing, Delivering, Or Administering Controlled Substance" provides, in part, that:  "(a)  A practitioner defined by Section 481.002(39)(A) may not prescribe, dispense, deliver, or administer a controlled substance or cause a controlled substance to be administered under the practitioner's direction and supervision except for a valid medical purpose and in the course of medical practice."

    Texas Health & Safety Code §481.072 "Medical Purpose Required Before Distributing or Dispensing Schedule V Controlled Substance" provides that: "A person may not distribute or dispense a controlled substance listed in Schedule V except for a valid medical purpose."

    http://www.statutes.legis.state.tx.us/Docs/HS/pdf/HS.481.pdf

    United States Code of Federal Regulations; 21 CFR §1306.03 "Persons Entitled to Issue Prescriptions" provides that: "(a) A prescription for a controlled substance may be issued only by an individual practitioner who is: (1) Authorized to prescribe controlled substances by the jurisdiction in which he is licensed to practice his profession and (2) Either registered or exempted from registration pursuant to 1301.22(c) and 1301.23 of this chapter. (b) A prescription issued by an individual practitioner may be communicated to a pharmacist by an employee or agent of the individual practitioner. [36 FR 7799, Apr. 24, 1971, as amended at 36 FR 18732, Sept. 21, 1971. Redesignated at 38 FR 26609, Sept. 24, 1973, as amended at 62 FR 13966, Mar. 24, 1997]"

    With regard to "Dangerous Drugs," Texas Health & Safety Code §483.001(2) "Definitions" provides that: "In this chapter: 'Dangerous drug' means a device or a drug that is unsafe for self-medication and that is not included in Schedules I through V or Penalty Groups 1 through 4 of Chapter 481 (Texas Controlled Substances Act). The term includes a device or a drug that bears or is required to bear the legend: (A) 'Caution: federal law prohibits dispensing without prescription' or 'Rx only' or another legend that complies with federal law; or (B) 'Caution: federal law restricts this drug to use by or on the order of a licensed veterinarian.'"

    Furthermore, with regard to "Dangerous Drugs," the Texas Health & Safety Code provides for the following:

    Texas Health & Safety Code §483.045 "Forging or Altering Prescription" provides that: "(a) A person commits an offense if the person: (1) forges a prescription or increases the prescribed quantity of a dangerous drug in a prescription; (2) issues a prescription bearing a forged or fictitious signature; (3) obtains or attempts to obtain a dangerous drug by using a forged, fictitious, or altered prescription; (4) obtains or attempts to obtain a dangerous drug by means of a fictitious or fraudulent telephone call; or (5) possesses a dangerous drug obtained by a forged, fictitious, or altered prescription or by means of a fictitious or fraudulent telephone call. (b) An offense under this section is a Class B misdemeanor unless it is shown on the trial of the defendant that the defendant has previously been convicted of an offense under this chapter, in which event the offense is a Class A misdemeanor."

    Texas Health & Safety Code §483.046 "Failure to Retain Prescription" provides that: "(a) A pharmacist commits an offense if the pharmacist: (1) delivers a dangerous drug under a prescription; and (2) fails to retain the prescription as required by Section 483.023. (b) An offense under this section is a Class B misdemeanor unless it is shown on the trial of the defendant that the defendant has previously been convicted of an offense under this chapter, in which event the offense is a Class A misdemeanor."

    Texas Health & Safety Code §483.047 "Refilling Prescription Without Authorization" provides that: "(a) Except as authorized by Subsection (b), a pharmacist commits an offense if the pharmacist refills a prescription unless: (1) the prescription contains an authorization by the practitioner for the refilling of the prescription, and the pharmacist refills the prescription in the manner provided by the authorization; or (2) at the time of refilling the prescription, the pharmacist is authorized to do so by the practitioner who issued the prescription. (b) A pharmacist may exercise his professional judgment in refilling a prescription for a dangerous drug without the authorization of the prescribing practitioner provided: (1) failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering; (2) either: (A) a natural or manmade disaster has occurred which prohibits the pharmacist from being able to contact the practitioner; or (B) the pharmacist is unable to contact the practitioner after reasonable effort; (3) the quantity of drug dispensed does not exceed a 72-hour supply; (4) the pharmacist informs the patient or the patient's agent at the time of dispensing that the refill is being provided without such authorization and that authorization of the practitioner is required for future refills; and (5) the pharmacist informs the practitioner of the emergency refill at the earliest reasonable time. (c) An offense under this section is a Class B misdemeanor unless it is shown on the trial of the defendant that the defendant has previously been convicted under this chapter, in which event the offense is a Class A misdemeanor."

    Texas Health & Safety Code §483.048 "Unauthorized Communication of Prescription" provides that: "(a) An agent of a practitioner commits an offense if the agent communicates by telephone a prescription unless the agent is designated in writing under Section 483.022 as authorized by the practitioner to communicate prescriptions by telephone. (b) An offense under this section is a Class B misdemeanor unless it is shown on the trial of the defendant that the defendant has previously been convicted of an offense under this chapter, in which event the offense is a Class A misdemeanor."

    Texas Health & Safety Code §483.022 "Practitioner's Designated Agent; Practitioner's Responsibilities" provides that: "(a) A practitioner shall provide in writing the name of each designated agent as defined by Section 483.001(4)(A) and (C), and the name of each healthcare facility which employs persons defined by Section 483.001(4)(B). (b) The practitioner shall maintain at the practitioner's usual place of business a list of the designated agents or healthcare facilities as defined by Section 483.001(4). (c) The practitioner shall provide a pharmacist with a copy of the practitioner's written authorization for a designated agent as defined by Section 483.001(4) on the pharmacist's request. (d) This section does not relieve a practitioner or the practitioner's designated agent from the requirements of Subchapter A, Chapter 562, Occupations Code. (e) A practitioner remains personally responsible for the actions of a designated agent who communicates a prescription to a pharmacist. (f) A practitioner may designate a person who is a licensed vocational nurse or has an education equivalent to or greater than that required for a licensed vocational nurse to communicate prescriptions of an advanced practice nurse or physician assistant authorized by the practitioner to sign prescription drug orders under Subchapter B, Chapter 157, Occupations Code."

    Texas Health & Safety Code §483.049 "Failure to Maintain Records" provides that: "(a) A person commits an offense if the person is required to maintain a record under Section 483.023 or 483.024 and the person fails to maintain the record in the manner required by those sections. (b) An offense under this section is a Class B misdemeanor unless it is shown on the trial of the defendant that the defendant has previously been convicted of an offense under this chapter, in which event the offense is a Class A misdemeanor."

    http://www.statutes.legis.state.tx.us/Docs/HS/pdf/HS.483.pdf

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  5. Do Podiatrists conduct “History & Physicals” ... and make "Hospital Admissions"? What about "Federal Motor Carrier Safety Administration (FMCSA) DOT Medical Exams & Commercial Motor Vehicle Certifications"? What about "University Interscholastic League (UIL) Pre-Participation Physical Evaluations - Physical Examinations"?

    History & Physicals - Hospital Admissions: It falls within a Podiatrist's scope of practice and licensure to conduct “History and Physicals,” limited only by the position of the hospital/surgery center/entity/facility where privileges are granted (See Q&A #1 - Scope of Practice). Please click on the following to view the "November 27, 2006 Federal Register; Section 482.22(c)(5) Condition of Participation: Medical Staff" which provides, in part, that a physician (as defined in section 1861(r) of the Act), oromaxillofacial surgeon, or other qualified individual could complete the H&P in accordance with State law and hospital policy. These updated federal regulations become effective on January 26, 2007.

    Furthermore, Texas Health & Safety Code §241.102 "Authorizations and Restrictions In Relation To Physicians and Podiatrists" provides that: "(a) This chapter does not authorize a physician or podiatrist to perform medical or podiatric acts that are beyond the scope of the respective license held. (b) This chapter does not prevent the governing body of a hospital from providing that: (1) a podiatric patient be coadmitted to the hospital by a podiatrist and a physician; (2) a physician be responsible for the care of any medical problem or condition of a podiatric patient that may exist at the time of admission or that may arise during hospitalization and that is beyond the scope of the podiatrist's license; or (3) a physician determine the risk and effect of a proposed podiatric surgical procedure on the total health status of the patient. (c) An applicant for medical staff membership may not be denied membership solely on the ground that the applicant is a podiatrist rather than a physician. (d) This chapter does not automatically entitle a physician or a podiatrist to membership or privileges on a medical staff. (e) The governing body of a hospital may not require a member of the medical staff to involuntarily: (1) coadmit patients with a podiatrist; (2) be responsible for the care of any medical problem or condition of a podiatric patient; or (3) determine the risk and effect of any proposed podiatric procedure on the total health status of the patient."

    Ultimately, privileging is a local matter between the applicant and medical staff. Nevertheless, within licensure/scope, a Podiatrist MAY perform a full H&P (i.e. head-toe) for podiatric admission, but only if credentialed to do so by medical staff (local control) and of course, if prudent to do so understanding that most facilities take a multi-disciplinary admission approach for patient safety. This "full H&P" would include addressing "other elements in a full H&P such as cardiac, medical and/or other non podiatric related elements." But, the Podiatrist would have to demonstrate his/her competency to medical staff to perform full H&P's (i.e. head-toe).

    The limitation here is that a Podiatrist could NOT perform a full H&P for a patient NOT undergoing podiatric medical (foot/ankle) treatment. For example, a facility could not authorize a Podiatrist to do a full H&P on a patient for "medical" conditions such as knee, hip, back, heart, brain surgery, etc. Meaning, while a Podiatrist can do a full H&P for foot/ankle surgery, that is not a waiver for a Podiatrist to do full H&P's for non-foot/ankle conditions.

    Credentialing is a matter for local determination and community standards.

    Federal Motor Carrier Safety Administration (FMCSA) "DOT Medical Exams & Commercial Motor Vehicle Certifications":

    NO. A Texas podiatrist can NOT conduct the testing and physical examination of body systems required on the "FMCSA-DOT Medical Examination Report", can NOT determine whether the driver is physically qualified to drive a CMV in interstate commerce, and can NOT complete the Medical Examiner’s Certificate. It falls outside the scope of practice for “Podiatry” in Texas for a Texas podiatrist to issue such a "FMCSA-DOT Medical Examination Report For Commercial Driver Fitness Determination” as rendering such a certification requires medical determinations for body systems beyond the Foot/Ankle.

    University Interscholastic League (UIL) "Pre-Participation Physical Evaluations - Physical Examinations":

    NO. A Texas podiatrist can NOT conduct the testing and physical examination of body systems required on the "UIL Pre-Participation Physical Evaluation/Examination Report". It falls outside the scope of practice for “Podiatry” in Texas for a Texas podiatrist to issue such a "UIL Pre-Participation Physical Evaluation/Examination Report" as rendering such a certification requires medical determinations for body systems beyond the Foot/Ankle.

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  6. For regulatory and compliance purposes, what portions of the Board Statute and Rules should Podiatrists make sure they know?

    Although the entire Podiatric Medical Practice Act (Texas Occupations Code - Chapter 202), the Board Rules (Texas Administrative Code - Title 22 / Part 18)  and related other State/Federal Laws/Rules are quite extensive, from a violation prevention perspective, it would be in a licensee’s best interest to be aware of the following "Board Statute & Rules Regulatory Hi-Lites." Please click here for a PDF document. Understanding common pitfalls affords for greater patient/public safety in preventing violations from occurring in the first place. NOTE: Formal “Disciplinary Actions” (Board Orders) are reported to the National Practitioner Data Bank (NPDB) and on the Board's website.

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  7. What does it mean if a Podiatrist’s license is in a “Delinquent” or "Cancelled" status; can they still practice?

    • If your license is EXPIRED ("DELINQUENT") or CANCELLED please read the following carefully.
    • Licensees who have submitted late renewals or have yet to submit a renewal have been placed in a “Delinquent” status. Please call the Board (512-305-7000) to determine if the renewal was received and if the license is “Active.” PENALTY FEES ACCRUE AFTER November 1st of each year.
    • Subject to certain limitations, a licensee in a “Delinquent” status is not fully prohibited from practicing during a 30-day grace period from November 1st - December 1st. If any entity providing the licensee clinical privileges wishes to restrict a licensee in a “Delinquent” status, for liability reasons, they may do so. Beginning on December 1st of each year, the Board will enforce practicing without a license penalties to include the issuance of "Cease & Desist Notices or Orders." There will NO longer be a one year grace period. However, "Delinquent" license holders will have one year to renew their license with PENALTY FEES from November 1st before their license is "Cancelled." [Posted 09/09/2007 @ 5:00 pm]
    • Again, a licensee can be in a “Delinquent” status for one year from the time of the renewal period (deadline is November 1st of each year) expiration, accruing penalty fees. [Posted 09/09/2007 @ 5:00 pm]
    • All "Delinquent" licenses are nevertheless subject to all administrative/criminal penalties of "Practicing Without A License." Any licensee in a "Delinquent" status shall not practice Podiatric Medicine after December 1st; criminal act pursuant to Texas Occupations Code §202.605.  [Posted 09/09/2007 @ 5:00 pm]
    • If a person's "Delinquent" license has been expired for one year or longer, the person may not renew the license. For purposes of public verification, the license is then considered to have been "Cancelled." [Posted 09/09/2007 @ 5:00 pm]
    • Any licensee in a "Cancelled" status shall not practice Podiatric Medicine; criminal act pursuant to Texas Occupations Code §202.605. "Cancelled" licensees are required to fully re-apply for licensure. That includes re-taking the TSBPME jurisprudence examination and having completed a one-year residency program accredited by CPME. [Posted 09/09/2007 @ 5:00 pm]

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  8. Do Podiatrists sign the written statement that accompanies the application for Disabled Person Placards and License Plates?

    Yes. Texas Transportation Code Chapter 681 "Privileged Parking" provides that the required notarized written statement or written prescription that accompanies the initial application for a disabled person identification placard or license plate can be issued by a person licensed to practice podiatry in this state or a state adjacent to this state ... for a person with a mobility problem caused by a disorder of the foot that limits or impairs that person's ability to walk. For more information, you may contact the Board or the Texas Department of Transportation at (512)-465-7719; (512)-465-7923.

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  9. Can Podiatrists use the word "Ankle" in an advertisement?

    Effective April 1, 2001 the restrictions on using the word "Ankle" in advertisements were lifted, pursuant to Board Rule §375.1(2) definition of "Foot." Although that Rule has since been deemed to be invalid effective July 30, 2010, the presiding Texas 3rd Court of Appeals May 23, 2008 Opinion does not prohibit "Ankle" treatments. 

    However, any such advertisements or trade names must be approved (Board Rule Chapter 373) by the Board. Any advertisements or trade names NOT approved by the Board are subject to investigation and administrative penalties.

    The Board approves practice/trade names from the standpoint that the name remains within the advertising scope of practice for podiatry. The final registration and utilization of any Board (scope) approved name rests upon the civil jurisdiction of the local County Clerk's office or the Texas Secretary of State.

    Additionally, with regard to "Advertising" in general and proper identification of a licensee's practice as being one of "Podiatry," each podiatric physician shall publish his/her own name and professionally identify himself/herself (i.e. DPM, Podiatrist, Etc.).

    The purpose of the Board's "Advertising" rules and of so limiting the professional designations of a podiatric physician and his/her practice's business is to ensure that the public and all prospective patients are reasonably informed of the distinction between podiatric physicians and other medical practitioners as is reflected by the difference in training and licensing, and the scope of practice.

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  10. Where can I find information to allow me (a Podiatrist) to prescribe Durable Medical Equipment (DME)? Also, can I own/operate a "Shoe Store" as part of my podiatry practice?

    Please contact Cigna Government Services (CGS) for DME MAC Jurisdiction C (for Texas):

    http://www.cgsmedicare.com/index.html

    As for Therapeutic Shoes, you may visit the following CMS website which explains coverage and legal requirements:

    November 2010 CMS - Therapeutic Shoe Policy Changes Physician Letter

    Non-Diabetic shoes ... a licensee may operate a "Shoe Store" as part of his/her practice and that essentially would be considered to be a separate business. When operating a "Shoe Store" the primary concern for the Board is that patients are properly aware of "Fees & Informed Consent". Please review Board Rule §375.19 "Fees and Informed Consent". Any "Advertising" of the same would need to be in compliance with Board Rule §373.13 "Advertising". The licensee will need to consult a healthcare/business attorney to assess his/her legal responsibilities.

    Diabetic Shoes ... are considered to be Durable Medical Equipment (DME) and the licensee would need to have a (federal) license to make those sales. Please contact Cigna Government Services (CGS) for additional information: http://www.cgsmedicare.com/index.html

    Be advised, when dealing with DME products, the licensee must follow contractual obligations with the Federal Medicare program. In the event a podiatrist is not a contracted DME provider, the doctor should provide the patient a prescription for the DME product so that the patient can obtain the product through an appropriate DME provider. If a DME product is not covered by Medicare, the doctor should notify the patient of the same and have them sign the Medicare-approved Advance Beneficiary Notice (ABN) in order for a cash-paying scenario to be valid.

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  11. I'm "Retiring"! What do I need to do in order to properly close my practice? What about practice/group departures?

    Ultimately, the expectation is that the decisions to be made during a practice departure will be of best benefit to the patients involved and their continuity of care; no matter who is treating them and where ... in the delivery of health care services. These guidelines are also responsive to other practice departure scenarios other than retirement, such as leaving a group practice or termination of a professional business relationship.

    Board Rule §375.3(b) "General" states: “A licensed podiatric physician shall conduct his practice on the highest plane of honesty, integrity, and fair dealing and shall not mislead his patients as to the gravity of such patient's podiatric medical needs. A podiatric physician shall not abandon a patient he has undertaken to treat. He may discontinue treatment after reasonable notice has been given to the patient by the podiatric physician of his intention to discontinue treatment and the patient has had a reasonable time to secure the services of another podiatric physician or all podiatric medical services actually begun have been completed and there is no contract or agreement to provide further treatment.”

    The Board does NOT intervene in civil/business/contractual/employment disputes; those are (peer-to-peer) civil or labor matters outside the Board's jurisdiction. Furthermore, doctors have taken an oath to heal and ultimately want successful patient encounters for patient well-being and the continuance of such relationships for the sake of the continuity of care. Patients want to be trusted and doctors want the trust of their patients together with following proper treatment plans. Patients may always discuss their concerns directly with their doctor verbally or in writing to seek a doctor-patient resolution; for overall best outcomes. These personal-professional and civil remedies are available for reasonable people to resolve reasonable disputes without government intervention.

    Medical Records. Be advised, common complaints received by the Board include the release of Medical Records (inability to obtain) or fees charged for the same. Be advised, Board Rule §375.21 relates to "Records"; the following is noted. The records of the identity, diagnosis, evaluation, or treatment of a patient by a podiatric physician that are created or maintained by a podiatric physician are the property of the podiatric physician. A podiatric physician shall furnish copies of medical records or a summary or narrative of the medical records pursuant to a written request. The podiatric physician providing copies of requested medical records or a summary or a narrative of such medical records shall be entitled to payment of a reasonable fee prior to release of the information unless the information is requested by a health care provider licensed in Texas or licensed by any state, territory, or insular possession of the United States or any State or Province of Canada if requested for purposes of emergency or acute medical care. Complaints which involve the inability to obtain medical records must evidence proof that a proper written request and payment was made in accordance with these rules. Verbal requests by patients to obtain records and refusal to pay do not meet proper release standards; such complaints will not be pursued.

    Regarding the actual cessation/leaving of one's practice, please be advised of the following General Considerations. This also applies to scenarios involving any discontinuance of practice, retirement and termination of employment.

    a) Although the Podiatric Medical Practice Act of Texas and the Board’s Rules do not contain specific language addressing the closing/transferring of one’s practice, the Podiatrist should have an attorney draw up the contract for the practice transfer. He/she should be sure to include, in the contract, specific, common sense language to ensure that his/her current patients are provided with an opportunity for continuity of care.

    b) Board Rule §375.21(a) "Records" provides that: “All podiatric physicians shall make, maintain, and keep accurate records of the diagnosis made and the treatment performed for and upon each of his or her patients for reference and for protection of the patient for at least five years following the completion of treatment.”

    c) Normally, when closing a practice, the Podiatrist advises his/her patients of the closure by sending them a postcard. That postcard would advise the patient: 1) of the closure; 2) where their medical records will be maintained, where the patients can access them & by what deadline and 3) where the patient can secure continuity of Podiatric care by contacting the appropriate healthcare practitioner/Podiatrist. Each patient should at least receive a letter or post card. A postcard may be the least expensive form of written notification. The Podiatrist can contact a local publisher for any bulk productions.

    d) However, if the items in "C" are not feasible, visible signage in and around the closing practice is standard, to alert active patients of the change. A voice message on the office answering machine/service giving information on the office status, who will be taking over the practice, and information on patient records, etc. is also recommended.

    e) Newspaper/radio/television/internet-website/etc. advertising would be optional and covered by the “reasonableness” of the time selected for the advertisement to run. A time period of  “one week” would be considered reasonable for a small municipality. A time period of several days a week, for several weeks to a month should be considered for larger/major municipalities. However, given the circumstances, if this is not feasible, then "D" suffices.

    f) Podiatrists MUST also notify the Board of any address changes via signed letter (Facsimile: 512-305-7003, ATTN: "Change of Address") or via our website at: "Change Your Address". Be sure to add "Comments" clarifying whether your practice closure is an outright one or a transfer/sale of practice to another provider (identify that provider/entity). Furthermore, be sure to update your "DPM Physician Profile" (licensee portal link) and make the same comments in the "Other services offered" section. With notification to the Board of an address change for the departing practitioners and the related upload (as a resource to the public) of new practice information to the Board's website (i.e. "DPM Physician Profile" ... public search portal link), patients can then at least be directed to the departing practitioners new location/contact information or have access to the new provider's contact information to obtain a copy of their medical records (upon proper written request).

    g) Board Rule §375.27 "Report Change of Practice Address and/or Phone Number to the Board" provides that: "It shall be the responsibility of each licensee to ensure that any change of address or phone number(s) for each licensees location(s) are reported in writing, via e-mail, facsimile or mail to the Board no later than 10 business days after the change is made. Failure to give written notification to the Board of these changes writing the required 10 business days shall result in an automatic administrative penalty of $10, for each business day that the information is not reported to the Board. The maximum penalty shall not exceed $300."

    In a group departure scenario (where practitioner(s) leave but other(s) stay), experience with such practice departure scenarios yields that once the departure occurs, patients are initially surprised at the change and then there is either communication or miscommunication amongst the practitioners involved as to what occurred and why...to/with patients. This is unfortunate and patients then can find themselves caught in the middle of a business/contractual dispute. This should be avoided by degreed professionals for the sake of their patients' health, well-being and safety. "Patient Abandonment" does not occur when the remaining/existing practice retains custody of patients/charts and assumes continuity of care.

    Following the aforementioned guidelines would serve the most prudent approach for a practice departure scenario to satisfy all parties involved.

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  12. I am a prospective patient, what can I do to research the background of a podiatrist or healthcare provider?

    There are several ways of doing this in addition to discussing your medical needs with your healthcare provider:

    1. Verify basic OnLine Podiatry Licensure Information.

    2. View/Print Board Disciplinary Actions.

    3. Conduct a Public Criminal History Search via the Texas Department of Public Safety.

    4. Review your doctor's DPM Physician Profile. This is a "Texas.Gov" service.

    5. Search Federal Healthcare Exclusion information via the United States Department of Health and Human Services - Office of Inspector General.

    6. Obtain Texas Medicaid Exclusion information via the Texas Health and Human Services Commission and/or the Texas Health and Human Services -  Office of Inspector General.

    7. Search Federal Student Loan Default information..

    8. Visit your or your doctor's County Clerk's Office to Obtain Civil and/or Malpractice Litigation information. For most counties, you will have to physically appear at the Clerk's Office to conduct a query. Some larger counties have that same information available on-line. To determine if your county has an on-line service, please visit the following Texas County Website List published by the Texas Association of Counties.

    9. View the TRAIL List of Texas State Agencies, who may also have jurisdiction over your doctor.

    10. Contact your Insurance Carrier to determine if they have any information on your doctor responsive to your request.

    11. For Medicare beneficiaries, search "Facilities & Doctors" (& much more) and can also conduct "Drug/Health Plan/Hospital/Facility - Comparisons".

    12. Search the provider at www.Google.com.

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  13. I am a Podiatrist who would like to include Hyperbaric Oxygen (HBO) therapy as part of my Wound Care treatments. What are the requirements, scope and regulations for me to perform HBO? What else should I know?

    June 23, 2014 Note: We are aware that Novitas has changed the HBO LCD for Podiatry. This limitation by Novitas affects Medicare and is a trade issue for remedy in the event a DPM has been negatively impacted. Please contact the Texas Podiatric Medical Association (TPMA) for assistance at 512-494-1123 to attend to any insurance/coverage/credentialing issues. Otherwise, the Board will continue to issue HBO Permits in accordance with Board Rule §375.5 & Attorney General Opinion DM-423.

    June 28, 2014 Note: We understand this matter has been resolved by Novitas. The information below remains current/valid with no changes.

    Hyperbaric Oxygen therapy involves placing (diving) a patient in a chamber filled with 100% oxygen, the atmospheric pressure of which has been increased. Be advised of the following concerning the scope of practice for Podiatric Medicine in the State of Texas regarding Hyperbaric Oxygen Therapy:

    • Section 202.001(4) of Texas Occupations Code (Statute) states: "Podiatry" means the treatment of or offer to treat any disease, disorder, physical injury, deformity, or ailment of the human foot by any system or method. The term includes podiatric medicine.

    • Section 375.5 of the Texas Administrative Code, Title 22, Part 18, (Rules) states: A Podiatric physician shall be recognized and permitted to supervise and administer hyperbaric oxygen following the published recommendations of the Undersea and Hyperbaric Medical Society, Inc. (UHMS) and within the credentials and bylaws of the hospital that operates the hyperbaric unit with the following stipulations:

      1. A podiatric physician practicing hyperbaric oxygen must do so in a hospital setting.

      2. The Podiatric physician must, in addition, show evidence of attendance and successful completion of a course of hyperbaric training that is recognized by the Undersea and Hyperbaric Medical Society. That person may only utilize hyperbaric oxygen in the treatment of the foot as recognized by the Podiatric Medical Act, Texas Civil Statutes, Article 4567, et seq. A person shall be regarded as practicing podiatric medicine within the meaning of this law and shall be deemed and construed to be a podiatric physician, who shall treat or offer to treat any disease or disorder, physical injury, or deformity, or ailment of the human foot by any system or method

      3. Prior to administering hyperbaric oxygen, a podiatric physician must have on file with the Texas State Board of Podiatric Medical Examiners documentation certifying compliance with the above requirements. [Note: CPR Requirements. Pursuant to Board Rule §378.1(e), proof of current C.P.R. training (basic or A.C.L.S.) must be hands-on; NO on-line CPR will be accepted.]

      4. A copy of the published recommendations of the Undersea and Hyperbaric Medical Society, Inc., are available from the Texas State Board of Podiatric Medical Examiners, P.O. Box 12216; Austin, Texas 78711-2216 or can be found at the afore link.

    The utilization of HBO by a Podiatrist, pursuant to the aforementioned requisite Board certification, is an approved modality pursuant to Board Rule §375.5 "Hyperbaric Oxygen Guidelines" and Attorney General Opinion DM-423 (11/06/1996). As long as the Podiatrist is performing dives on the "foot/ankle," he/she is authorized to utilize HBO.

    Due to the nature of HBO complications, it is required that the HBO facility be in a "hospital setting" to allow for other health professionals to be present in the event of a patient emergency. Location of the HBO facility within a "hospital campus" suffices the requirement that a "podiatric physician practicing HBO must do so in a hospital setting." Furthermore, in a large hospital (campus) setting, it is understood that the Podiatrist my have to leave the HBO facility to attend to matters at the main hospital building. Leaving the HBO facility would be allowable as long as appropriately trained staff could attend to the patient in a dive and that the Podiatrist be available when needed. Otherwise, the expectation is that the HBO facility be appropriately staffed at all times for the patient's well-being and the Podiatrist is responsible for his/her patients (at all times).

    In the past, it has been asked whether or not a Podiatrist can perform dives on conditions (hips, backs, torsos, etc.) beyond the scope of Podiatric Medicine. In response, the answer is "NO," unless he/she is acting under the delegation or orders of a Medical Doctor or Doctor of Osteopathic Medicine (MD/DO; licensed by the Texas Medical Board) pursuant to Texas Occupations Code §157.001 "General Authority of Physician to Delegate" (business of the Texas Medical Board). Even if a Podiatrist is acting under the proper/authorized delegation/order of a MD/DO for non-scope treatments, a MD/DO needs to be on-site at the HBO facility in the event there is a complication of the non-podiatric wound and the Podiatrist's medical records need to be sure to document their (co-)management of the patient with him/her and co-signatures. There is nothing in the law that precludes a Podiatrist from working together with Doctors of Medicine (MD/DO) for the common goal of patient welfare; wound care can be well managed together, by both professionals. However, it is imperative that the patient medical records accurately record the totality of the provision of HBO therapy and by whom. Furthermore, even upon proper/authorized MD/DO delegation to a Podiatrist for dives beyond the scope of Podiatric Medicine, individuals would also need to consider their malpractice coverage allowances/limitations/risks. With regard to a proper/authorized MD/DO to Podiatrist delegation scenario, consideration should also be given to proper billing for any dives beyond the scope of Podiatric Medicine as the Podiatrist would be considered a "technical assistant" practicing under the MD's/DO's license.

    Medical Staff at hospitals can enact their own restrictions/controls (by-laws) with respect to HBO treatments by a Podiatrist but they can NOT expand the scope set forth by the Board's laws/rules. Meaning, Medical Staff cannot authorize a Podiatrist to perform non-podiatric HBO treatments in the absence of a MD/DO delegation/order. For podiatric HBO treatments, the Podiatrist would be well within the scope to perform such treatments, upon  Board certification/registration pursuant to Chapter 375. For those "medical" treatments delegated by an MD/DO to the Podiatrist, be advised of the potential liability involved to the Podiatrist if the MD's/DO's do not adequately delegate/order, co-sign, co-manage and co-document their care. Again, proper medical record keeping and billing is imperative or the Podiatrist will be subject to Board disciplinary action.

    Lastly, pursuant to Medicare rules, another physician also trained in HBO must be readily available in case there is a problem in the chamber that is outside the scope of podiatric care. Former Trailblazer LCD on Hyperbaric Oxygen therapy: "Limited license physicians performing Hyperbaric Medicine services must have an unlimited license physician who is also credentialed in Hyperbaric Medicine by the hospital entity readily available to render assistance if needed." Furthermore, per Trailblazer (former), the chamber must be a "full-body" chamber and not just an "oxygen tent" set-up. For new HBO LCD's, please contact Novitas.

    The health and safety of patients shall be the first consideration of the Podiatric Physician.

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  14. I am a Podiatrist who is the subject of a complaint investigation filed by one of my patients. Is it o.k. for me to contact the patient to discuss his/her complaint while the Board investigates the matter?

    No. It is recommended that you do not contact the patient during an on-going investigation. If you contact the patient (complainant) a situation may be created where the complainant feels they are being harassed or intimidated by you (doctor/licensee); they may fear retaliation. Unnecessary contact only confounds & complicates the investigation for both parties. Once a case has been initiated by the Board, it is expected that the doctor/licensee cease all communications that are the subject of the complaint, with the complainant, unless necessary for the continuity of the patient's (complainant's) medical care or directed otherwise by your legal counsel.

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  15. I am a Podiatrist who is having problems with an (private) Insurance Company. I have been denied payment, my payments are not timely and I am having other business problems with the carrier which is having a negative impact on my practice. Who can assist me in filing a complaint to resolve these matters?

    The Texas State Board of Podiatric Medical Examiners has NO authority to proceed against an insurance company. However, you can file a complaint with the Texas Department of Insurance; click on the following link for more information: http://www.tdi.state.tx.us/hprovider/index.html.

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  16. Can a Podiatrist order and/or supervise the administering of anesthesia by a CRNA (Certified Registered Nurse Anesthetist)?

    The administration of anesthesia by a CRNA is under the regulation of the Texas Board of Nursing (TBON) and the Texas Medical Board (TMB) [Attorney General Opinion JC-0117 (09/28/1999)]. We recommend that requestors contact the TBON & TMB for further information. Podiatrists do request the provision of anesthesia services from the appropriate provider in consideration of the safety and well being of a patient.

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  17. I am a patient who has been the victim of a sexual impropriety/act/crime and boundary violation by a physician. Where can I find assistance and information with victims rights beyond solely filing a complaint with the Board or Law Enforcement?

    The Texas State Board of Podiatric Medical Examiners in conjunction with Law Enforcement authorities investigates any allegations of Sexual Misconduct/Crimes committed by a podiatric physician. While the Board focuses on the investigation, patients/victims can seek advocacy assistance/services or learn more information by contacting the following.

    Rehabilitation, continuing education (CME) and awareness information/services are also available for physicians through "Professional Boundaries Incorporated."

    In any instance involving victimization, "No Means NO!"

    Contacts for Patients/Victims:

    Contacts for Healthcare Professionals (only):

    General Contacts / Information:

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  18. As a patient or podiatric physician, where can I find information related to "Informed Consent Forms"?

    The Texas Medical Disclosure Panel publishes Rules and Forms related to "Informed Consent" under Title 25; Part 7; Chapter 601 of the Texas Administrative Code. Please click on the link for more information.

    Board Rule §375.19 “Fees and Informed Consent” provides that: “(a) The podiatric physician has special knowledge which his patient does not have; therefore, to avoid misunderstanding he should advise his patient in advance of beginning treatment of the nature and extent of the treatment needed; the approximate time required to perform the recommended treatment and services; and any further or additional services or return by the patient for treatment, adjustments, or consultation and the time in which this shall occur. A podiatric physician should inform his patients as to the fees to be charged for services before the services are performed, regardless of whether the fees are charged on a case basis, on the basis of a separate charge for each service, or a combination of these two methods, or some other basis. If an exact fee for a particular service, as in extended care cases, cannot be quoted to a patient, a fair and reasonable estimate of what the fee will be and the basis on which it will be determined should be given the patient. (b) A podiatric physician shall not tender or receive a commission for a referral.”

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  19. I suspect Child Abuse/Neglect/Sexual Exploitation. I also suspect Elder Abuse/Neglect. What do I do?

    Whether or not you are a Podiatric Physician, under Texas Family Code Chapter 261, ANYONE having cause to believe that a child's physical or mental health or welfare has been or may be adversely affected by abuse or neglect MUST REPORT the case IMMEDIATELY to a state or local law enforcement agency or the Texas Department of Family and Protective Services (TDFPS). Click Here for a "General Guide" published by the Texas Office of the Attorney General. Also, TDFPS has a toll-free, 24-hour Family Violence Hotline: 1-800-252-5400 to report Child/Elder Abuse/Neglect. Click on the following link to read more about Elder Abuse/Neglect: "Elder Abuse is Everyone's Business"

    In addition, Texas Penal Code §38.17 "Failure to Stop or Report Aggravated Sexual Assault of Child" and Texas Penal Code §38.171 "Failure to Report Felony" provides criminal penalties for other failures to act.

    Furthermore, with regards to Sexual Exploitation of Children, any person may contact the National Center for Missing and Exploited Children and report concerns as well to The Cyber TipLine. These public efforts are coordinated with the appropriate law enforcement agencies.

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  20. What are the Medicare regulations relating to Podiatrist orders and debridement of mycotic/dystrophic nail tissue in a nursing home setting? What about "Healthcare Fraud" prevention and creating a "Compliance Program" to prevent the same?

    [Medicare is a federal health insurance program established by Congress in 1965 to provide health care insurance for seniors and people with disabilities (added in 1972). The Medicare program has two components, Part A and Part B. Part A provides coverage for services from institutional providers such as hospitals and skilled nursing facilities. Part B provides coverage for services from physicians, non-physician practitioners, laboratories and suppliers.]

    (Note: References to Trailblazer Health Enterprises, LLC now mean Novitas Solutions.) For reference, requestors can visit Trailblazer Health Enterprises, LLC directly at http://www.trailblazerhealth.com for further information. TrailBlazer Health Enterprises, LLC is an independent licensee of the Blue Cross and Blue Shield Association and administers the Medicare program under contracting arrangements with the Centers for Medicare & Medicaid Services (CMS). On their website, one can access “Local Coverage Determinations” (LCD) under the “Policies” link for “Part B & J4” policies. “Routine Foot Care and Debridement of Mycotic Nail” provisions can be found under “R.” The following is provided:

    • ... Documentation of foot-care services to residents of nursing homes not performed solely at the request of the patient or patient’s family/conservator must include a current nursing facility order (dated and signed with date of signature) for routine foot care service issued by the patient’s supervising physician that describes the specific service necessary. Such orders must meet the following requirements:
      • The order must be dated and must have been issued by the supervising physician prior to foot-care services being rendered.
      • Telephone or verbal orders not written personally by the supervising physician must be authenticated by the dated physician’s signature within a reasonable period of time following issuance of the order.
      • The order must be consistent with the attending physician’s overall plan of care.
      • The order must be for medically necessary services to address a specific patient complaint or physical finding.
      • Routinely issued or “standing” facility orders for routine foot-care services and orders for non-specific foot-care services that do not meet the above requirements are insufficient.
    • Documentation of foot-care services to residents of nursing homes performed solely at the request of the patient or patient’s family/conservator should name the person who requested the services and should identify the requesting person’s relationship to the patient ...

    Medical necessity withstanding, when any orders are written (hospital or nursing home), those orders are addressed to a "specific" physician (i.e. by name). Therefore, the order cannot state “…Podiatrist to ... do something….” The order must also specify what the ordering physician expects the latter physician to treat or do.

    Any persons suspected of treating any disease, disorder, physical injury, deformity, or ailment of the human foot by any system or method, other than a Podiatrist or Medical Doctor, will be viewed as practicing Podiatric Medicine without a license (criminal offense).

    A medical assistant can NOT go out to Nursing Homes and trim nails under Medicare/Medicaid provisions as billing for those procedures requires medical necessity.

    With regard to diabetic patients and invasive procedures, NO untrained person should be treating such patients. A medical assistant that does not have any certifications or licenses to do debridements on ulcers and trim nails on diabetic patients should NOT be treating diabetic patients.

    Medicare/Medicaid/Private Insurance does NOT pay a podiatrist for pedicure (nail salon) services (no matter the service location); medical necessity must be established ... and by that virtue only the DPM can provide "Foot" treatments in a Nursing Home and validly bill for valid necessary "Podiatry" services. A medical assistant can NOT treat patients in a Nursing Home. The originating "Physician" (MD/DO) order for "Foot" treatment is directed towards the licensed DPM and NOT the DPM's "assistant".

    The aforementioned Medicare LCD provisions from Trailblazer Health Enterprises, LLC can be found HERE. For further inquiries, requestors will need to contact Trailblazer Health Enterprises, LLC or requestors may also contact the Texas Podiatric Medical Association (TPMA) at 512-494-1123 and ask for their “Medicare Liaison.” Nevertheless, since these are federal provisions and due to high exposure for “Healthcare Fraud” in the event Local Coverage Determinations are not met as stipulated, it is recommended that Trailblazer Health Enterprises, LLC be contacted for further education/information.

    With regard to "Healthcare Fraud" prevention and creating a "Compliance Program" to prevent the same, it is recommended that licensees review and follow the "OIG Compliance Program for Individual and Small Group Physician Practices" (PDF). This is a product of the United States Department of Health and Human Services - Office of Inspector General: "This Federal Register notice sets forth the recently issued Compliance Program for Individual and Small Group Physician Practices developed by the Office of Inspector General (OIG). The OIG has previously developed and published voluntary compliance program guidance focused on several other areas and aspects of the health care industry. We believe that the development and issuance of this voluntary compliance program guidance for individual and small group physician practices will will serve as a positive step towards assisting providers in preventing the submission of erroneous claims or engaging in UNLAWFUL CONDUCT involving the Federal health care programs."

    To report suspected "Medicare/Medicaid Fraud, Waste & Abuse" call toll free 1-800-HHS-TIPS (1-800-447-8477). This service is a product of the United States Department of Health & Human Services - Office of Inspector General.

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  21. I am a patient with a billing problem. I had seen my doctor who is an out of network provider for my insurance plan. I am now stuck with a large bill for "usual and customary" rates that are not covered and I can't afford this. What can be done?

    First, the Texas State Board of Podiatric Medical Examiners has NO authority to proceed against an insurance company. However, you can file a complaint with the Texas Department of Insurance.

    The following is from the Office of the New York State Attorney General: "...In February 2008, the Attorney General announced an industry-wide investigation into allegations that health insurers unfairly saddle consumers with too much of the cost of out-of-network health care. Seventy percent of insured working Americans pay higher premiums for insurance plans that allow them to use out-of-network doctors. In exchange, insurers often promise to cover up to eighty percent of the 'usual and customary' rate of the out-of-network expenses, and consumers are responsible for paying the balance of the bill..." Please CLICK HERE to view the related State of New York press release.

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  22. Can a Podiatrist advertise and promote an off-label non-FDA approved use of lasers (& other drugs/devices) for toenail fungus treatment? Can a Podiatrist provide fingernail fungus (laser) treatment, even upon a prescription from a MD/DO or APN-NP/PA requesting such fingernail treatment?

    With regard to laser devices, all lasers are regulated by the Texas Department of State Health Services - Radiation Control Program (DSHS). We suggest that they be contacted with regard to registration, use and safety standards for such a device. http://www.dshs.state.tx.us/radiation/laser.shtm

    Podiatrists in Texas can treat the "foot/ankle" by "any system or method" and this COULD include the use of laser devices so long as it is properly registered with DSHS, used safely & for its intended purpose and not prohibited by any other regulatory agency. The possibility exists that some “Laser” treatments may be the practice of "Medicine" (the field regulated by the Texas Medical Board), such as when it comes to laser treatments and possibly cosmetic surgery, depending on what actually will be occurring. There is also a Texas Spa Act (Texas Occupations Code Chapter 702) that could have an applicability of jurisdiction. Therefore, the use of “Lasers” are subject not only to Podiatry Regulations, but also to those of the Texas Cosmetology Commission (i.e. the Texas Department of Licensing & Regulation), the Texas Department of State Health Services, the Texas Medical Board, the Texas Spa Act and the U.S. Food & Drug Administration (FDA).

    With regard to podiatrists advertising and promoting an off-label use of lasers for toenail fungus treatment, the U.S. Food & Drug Administration has regulations that govern misbranding, mislabeling and false advertising by manufacturers. Medical providers are restricted from advertising or promoting an off-label indication to attract patients for an off-label procedure; such promotion and inducement of an off-label therapy is misleading/deceptive. Patients should be notified by the Podiatrist of any off-label use of (drugs &) devices and informed consent should be obtained for the safety of the patient.

    Board Rule §373.13 “Advertising” provides, in part, that: “(a) A podiatric physician may advertise. A podiatric physician shall not, however, use or participate in the use of any publication, including advertisements, news stories, press releases, and periodical articles, that contains a false, fraudulent, misleading, deceptive, scientifically unsupported or generally unaccepted, or unfair statement or claim, or that are exaggerations or are untrue. (b) A false, fraudulent, misleading, deceptive, scientifically unsupported or generally unaccepted, or unfair statement or claim includes but is not limited to, a statement or claim that: (1) contains a misrepresentation of fact, or claims as fact something that has not been generally accepted among the podiatric community or by the Board as having been proven or established as fact; (2) is likely to mislead or deceive or entice or persuade a reasonable person because it fails to make full disclosure of relevant facts whether regarding fees, modes of treatment, conditions or techniques of surgery, post-operative conditions such as degree of pain, length of time of recovery, mobility and strength during recovery, and the like; (3) is intended or likely to create in an ordinary reasonable person false or unjustified expectations of favorable results; (4) states or implies educational or professional attainments or licensing recognition not supported in fact; (5) states or implies that the podiatric physician has received formal recognition as a specialist, or has any specialized expertise if this is not the case; (6) contains any laudatory statement, or other statement or implication that the podiatric physician's services are of exceptional quality; (7) contains statistical data or information that reflects or is intended to reflect quality or degree of success of past performance, or prediction of future success; (8) represents that podiatric services can or will be completely performed for a stated fee amount when this is not the case, or makes representations with respect to fees that do not disclose all variables affecting the fees, or makes representations that might reasonable cause an ordinary prudent person to misunderstand or be deceived about the fee amount; (9) contains a testimonial; (10) represents that health care insurance deductibles or co-payments may be waived or are not applicable to health care services to be provided if the deductibles or co-payments are required; (11) represents that the benefits of a health benefit plan will be accepted as full payment when deductibles or co-payments are required. (f) If a publication by or for a podiatric physician includes mention of a particular surgical technique or device, such as laser surgery, minimal incision surgery, laser bunion surgery or similar particular techniques or devices, the publication must also include a specific and true statement that reveals to an ordinary reasonable person the limits and scope and specific purpose of the technique so as not to mislead an ordinary reasonable person regarding the difficulty, pain or discomfort, length of time for surgery or recuperation, or possibility of complications.”

    Board Rule §373.15 “Violations” provides that: “(a) Any person who violates this chapter et seq., or a determination of the Board hereunder is subject to a administrative penalty of up to $500 for each day of violation. (b) In addition, failure of a podiatric physician licensed by the Board to identify his practice consistent with this chapter is subject to the penalties provided by Chapter 376 of this title (relating to Violations and Penalties). (c) At the request of the board, the attorney general shall institute and conduct the action in the name of the state.”

    Board Rule §375.19 "Fees and Informed Consent" provides that: "The podiatric physician has special knowledge which his patient does not have; therefore, to avoid misunderstanding he should advise his patient in advance of beginning treatment of the nature and extent of the treatment needed; the approximate time required to perform the recommended treatment and services; and any further or additional services or return by the patient for treatment, adjustments, or consultation and the time in which this shall occur. A podiatric physician should inform his patients as to the fees to be charged for services before the services are performed, regardless of whether the fees are charged on a case basis, on the basis of a separate charge for each service, or a combination of these two methods, or some other basis. If an exact fee for a particular service, as in extended care cases, cannot be quoted to a patient, a fair and reasonable estimate of what the fee will be and the basis on which it will be determined should be given the patient. (b) A podiatric physician shall not tender or receive a commission for a referral."

    Engaging in grossly unprofessional or dishonorable conduct of a character that in the Board's opinion is likely to deceive or defraud the public and using any advertising statement of a character tending to mislead or deceive the public is prohibited in accordance with Texas Occupations Code §202.253(a)(4)(6).

    The American Podiatric Medical Association (APMA) provides the following:

    “Refresher on "Off-Label" Use of Marketed Drugs and Medical Devices Sound medical practice and the best interests of the patient require that podiatrists use legally available drugs and devices according to their best knowledge and judgment. However, podiatrists may routinely utilize a Food and Drug Administration (FDA)-approved drug or medical device to treat a condition or perform a surgical procedure for which the product has not yet been approved. Podiatrists may receive information about the success of such off-label use from colleagues, seminars, medical literature, and, in some cases, from the manufacturer itself. In these cases, the podiatrist has the responsibility to be well-informed about the product; to base its use on firm, scientific rationale and on sound medical evidence; and to maintain records of the product's use and effects. When using a drug or device for an off-label use, DPMs should inform the patient of this use, advise the patient of possible complications, and document this conversation in the patient's medical record.

    While off-label use of a prescription drug or device by medical practitioners can contribute to a manufacturer's success, FDA regulations allow manufacturers to promote only approved indications for drugs and devices. FDA permits a manufacturer to disseminate only educational, "non-promotional" materials about non-approved indications or uses, such as peer-reviewed medical journal articles and reports of clinical studies. FDA also requires that if a manufacturer wants to disseminate information about the new use, it must have a pending application to FDA for approval of the new use, provide the FDA-approved labeling for the current indications, or use and make it clear that the off-label use of the product described in materials is not yet FDA-approved. Similarly, podiatrists cannot promote or advertise the off-label use of a drug or device. The podiatrist can, however, advise a patient seeking treatment of the off-label medication or device when the patient presents with a condition for which the podiatrist determines that the off-label medication or device is in the patient's best interest.

    If you have questions about the appropriateness of devices used in your practice, visit www.fda.gov for more information."

    Can a Podiatrist provide fingernail fungus (laser) treatment, even upon a prescription from a MD/DO or APN-NP/PA requesting such fingernail treatment?

    NO. A license to practice Podiatry is limited to treatment of the Foot/Ankle. Fingernail Laser Therapy by a Podiatrist is outside the scope of practice for Podiatry and is NOT permissible.

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  23. Can a Podiatrist employ/supervise an Advanced Practice Nurse (APN) or Physician Assistant (PA) and delegate podiatric/medical treatments to an APN/PA (Physician Extenders)?

With regard to Advanced Practice Nurses (APN; which include Nurse Practitioners) & Physician Assistants (PA), the answer is "NO," a Texas Podiatrist (DPM) can NOT employ an APN nor PA. Advanced Practice Nurses and Physician Assistants can only work under the delegation of a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) (i.e. "Physicians") licensed by the Texas Medical Board. This is due to State Law: Texas Occupations Code Chapter 157 (Subchapter B. Delegation To Advanced Practice Nurses and Physician Assistants; §157.051. Definitions; et. al.) found within the Medical Practices Act; Texas Occupations Code Chapter 100's relating to the practice of "Medicine" (MD/DO) & the Texas Medical Board. In the Medical Practices Act, there are statutory provisions that establish relationships between MD's/DO's and APN's/PA's. The virtue of APN/PA practice is the contingency of their activities under the delegation/licensure of a MD/DO. However, in the Podiatric Medical Practice Act of Texas (i.e. Texas Occupations Code Chapter 202; Texas State Board of Podiatric Medical Examiners), there are NO statutory references/provisions establishing relationships amongst DPM's and APN's/PA's. Again, there is NO provision in the Podiatric Medical Practice Act of Texas (Texas Occupations Code Chapter 202) that allows a Texas Podiatrist to employ/supervise an APN/PA or to delegate podiatric/medical treatments to an APN/PA (Physician Extenders).

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  1. Can a Podiatrist be a "Medical Director" of a clinic/facility?

Although the Board does not have any law/rule/regulation prohibiting a podiatrist from acting as a "Medical Director" for a facility, the podiatrist MUST still only act within the foot/ankle scope of practice for podiatry/podiatric medicine. A podiatrist's position as a "Medical Director" can NOT supersede the scope of practice limitations for podiatry/podiatric medicine. In other words, the position of "Medical Director" is NOT a license for a podiatrist to practice "Medicine" (the field for Medical Doctors and Doctors of Osteopathic Medicine licensed by the Texas Medical Board) in the State of Texas. A podiatrist can only practice podiatry/podiatric medicine.

Consideration of facility bylaws should also be given regarding a "Podiatrist Medical Directorship." Such a possibility would appear to be further defined by bylaws of the facility on a director's role for staff/business management, administration, (multi-disciplinary) service coordination, program/practice guidelines and risk management. For example, in a "Wound Care" facility scenario, while one could argue that a podiatrist could act as a "Medical Director" due to the fact that any "doctor" at the facility would be their own practitioner with their own license/scope, a problem could arise if a (wound care) facility is staffed with non-doctors (nurses for example). In such a scenario, a nurse would have to obtain orders for all (body) wounds. If orders for (body) wounds beyond the foot/ankle were made by a podiatrist, then that would be outside the scope of practice for podiatry/podiatric medicine. Again, the practice of podiatry/podiatric medicine is limited to treatment of the foot/ankle and the podiatrist must be clearly identified as a "DPM, Podiatrist, Podiatric Physician, etc.". The purpose of proper identification of a podiatrist is to insure that the public and all prospective patients are reasonably informed of the distinction between podiatric physicians and other medical practitioners as is reflected by the difference in training and the scope of practice. Nevertheless, podiatrists are permitted to work in a group setting composed of practitioners from different branches of the healing arts.

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  1. Can a Podiatrist be a "Surgical Assistant" for non-podiatry procedures?

First and foremost, a podiatrist is licensed to practice podiatry/podiatric medicine and the first consideration of the podiatric physician is the health and safety of patients. For surgical assisting in non-podiatry procedures, a DPM license is NOT a "Surgical Assistant" license.

"Surgical Assistants" are licensed by the Texas Medical Board (Texas Occupations Code Chapter 206 and related Texas Medical Board rules). "Physicians" (i.e. MD/DO; licensed by the Texas Medical Board) have the statutory authority to delegate certain medical acts (Texas Occupations Code §157.001 "General Authority of Physician to Delegate") to other persons but that is the business of the Texas Medical Board.

If called upon and delegated by a "Physician" (i.e. MD/DO), subject also to hospital credentialing, a podiatrist could assist in non-podiatry procedures while under the direct supervision/order of the "Physician" but only if not in violation of any other law (business of the Texas Medical Board). Individuals would also need to consider their malpractice coverage allowances/limitations/risks. Nevertheless, should a podiatrist assist in any (MD/DO authorized/delegated) non-podiatry procedure, he/she is considered to be a "technical assistant." Podiatrists in such a scenario cannot be considered a primary "Physician/Surgeon" nor can they be considered a secondary "Physician/Assistant Surgeon." In the event the secondary surgeon/assistant surgeon has to assume the responsibilities of the primary, it is not within a podiatrist's scope/licensure to take over as the podiatrist would be a "technical assistant." Billing for the podiatrist's "technical assistant" role would also need to follow accordingly.

Again, Texas Occupations Code Chapter 206 sets forth license requirements for "Surgical Assistants" and makes the field of "Surgical Assistant" licensure/practice the business of the Texas Medical Board. The term "Physician" means a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) licensed by the Texas Medical Board.

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  1. Can a Podiatrist administer Nitrous Oxide (N2O) to patients? What about General Anesthesia?

To employ nitrous oxide/oxygen inhalation conscious sedation for any medical purpose, the podiatric physician must obtain a permit from the Texas State Board of Podiatric Medical Examiners and may only employ N2O within the scope of practice for Podiatric Medicine in the State of Texas. The practice of Podiatry is limited to treatment of the Foot/Ankle.

Conscious sedation is the production, be pharmacological or non-pharmacological methods, or a combination thereof, of an altered level of consciousness in a patient. Conscious sedation of a patient by nitrous oxide is the administration by inhalation of a combination of nitrous oxide and oxygen producing a minimally depressed level of consciousness while retaining the patient's ability to maintain a paten airway independently and continuously, and to respond appropriately to physical stimulation and verbal command. Conscious sedation of a patient by nitrous oxide shall be induced, maintained, and continuously supervised only by the podiatric physician or by the assistant under continuous direct supervision of the podiatric physician. The nitrous oxide shall not be flowing if the podiatric physician is not present in the room. The podiatric physician must be present at all-times and cannot delegate the administration of nitrous oxide to any other person.

The utilization of N2O by a podiatrist, pursuant to the aforementioned requisite Board certification, is an approved modality pursuant to Board Rule §375.7 "Nitrous Oxide/Oxygen Inhalation Conscious Sedation Guidelines" and Attorney General Opinion MW-435 (02/01/1982). As long as the podiatrist is performing N2O for purposes of the practice of Podiatry, he/she is authorized to employ N2O.

Board Rule §375.3 “General” provides that: “(a) The health and safety of patients shall be the first consideration of the podiatric physician. The principal objective to the podiatric profession is to render service to humanity. A podiatric physician shall continually strive to improve his medical knowledge and skill for the benefit of his patients and colleagues. The podiatric physician shall administer to patients in a professional manner and to the best of his ability. Secrets and personal information entrusted to him shall be held inviolate unless disclosure is necessary to protect the welfare of the individual or the community. A podiatric physician shall be temperate in all things in recognition that his knowledge and skill are essential to public health, welfare, and human life. (b) A licensed podiatric physician shall conduct his practice on the highest plane of honesty, integrity, and fair dealing and shall not mislead his patients as to the gravity of such patient's podiatric medical needs. A podiatric physician shall not abandon a patient he has undertaken to treat. He may discontinue treatment after reasonable notice has been given to the patient by the podiatric physician of his intention to discontinue treatment and the patient has had a reasonable time to secure the services of another podiatric physician or all podiatric medical services actually begun have been completed and there is no contract or agreement to provide further treatment.”

Board Rule §375.11 “Offices” provides that: “(a) It is an objective of the Podiatric Medical Practice Act and a policy of the Board that the public be properly informed concerning the availability and level of podiatric medical services in every community where a podiatric medical office is located. To accomplish this objective, a podiatric physician shall not establish or be affiliated with an office which does not comply with these sections. (b) All podiatric medical offices shall contain the minimum amount of treatment equipment and facilities so that the podiatric physician may provide his usual and customary podiatric medical services. (c) The office shall be attended by the podiatric physician on a routine schedule and frequently enough so that treatment is timely and convenient for the patients in the area where the office is located. (d) All offices shall be staffed or equipped so that patients and the public can conveniently determine when the podiatric physician will be in his office. Examples of how this information might be provided are an answering service or an automatic telephone listening and recording device of some type. (e) This section does not prohibit a podiatric physician from practicing in communities which are too small to economically justify or otherwise warrant the establishment of an office, but when a podiatric physician undertakes to practice in such communities, he must have sufficient staff and equipment or facilities available to provide safe treatment.”

Board Rule §375.19 “Fees and Informed Consent” provides that: “(a) The podiatric physician has special knowledge which his patient does not have; therefore, to avoid misunderstanding he should advise his patient in advance of beginning treatment of the nature and extent of the treatment needed; the approximate time required to perform the recommended treatment and services; and any further or additional services or return by the patient for treatment, adjustments, or consultation and the time in which this shall occur. A podiatric physician should inform his patients as to the fees to be charged for services before the services are performed, regardless of whether the fees are charged on a case basis, on the basis of a separate charge for each service, or a combination of these two methods, or some other basis. If an exact fee for a particular service, as in extended care cases, cannot be quoted to a patient, a fair and reasonable estimate of what the fee will be and the basis on which it will be determined should be given the patient. (b) A podiatric physician shall not tender or receive a commission for a referral.”

Board Rule §375.21(a) “Records” provides that: “All podiatric physicians shall make, maintain, and keep accurate records of the diagnosis made and the treatment performed for and upon each of his or her patients for reference and for protection of the patient for at least five years following the completion of treatment.”

Office-based procedures should not be a substitute to treat a patient outside a (properly credentialed) hospital or ambulatory surgical clinic/center setting when the standard of care dictates that a patient be treated in those settings; for the health, safety and well-being of the patient.

It is imperative during the Pre-Operative Evaluation that the podiatric physician evaluate and document in the patient's medical record, prior to the nitrous oxide/oxygen inhalation conscious sedation procedure, the patient's health and medical status to ensure that nitrous oxide/oxygen inhalation conscious sedation is medically appropriate.

Podiatry offices/practices must meet all cleanliness, sterility and infection-control standards; for the health, safety and well-being of the patient.

With regard to all credentialing/privileging issues, that is a matter for local control between the individual podiatrist and the facility in accordance, in part, with Texas Health & Safety Code Subchapter E relating to Medical Staff Membership & Privileges §241.101 et al. Privileges are granted by hospital credentialing committees upon consideration of a podiatrist’s individual training, experience, certifications and qualifications. For any/all requested privileges, the podiatrist should demonstrate training and proficiency (e.g. via surgical logs or proctoring). A hospital would have to consider their own policies regarding privileges for conscious sedation.

It is further noted that the Board N2O rules do not explicitly address whether or not a podiatrist is authorized to administer moderate sedation, such as versed. Persons who administer anesthetics such as nitrous oxide are subject to liability for injuries caused to a patient by their negligent administration thereof.

With regard to general anesthesia, a license to practice podiatry is NOT a license for a podiatrist to administer general anesthesia. Nevertheless, podiatrists do request the provision of anesthesia services from the appropriate provider (whether that is from a MD/DO Anesthesiologist or CRNA) in consideration of the safety and well being of a patient.

The health and safety of patients shall be the first consideration of the Podiatric Physician.

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  1. Does a Radiology Technician certification authorize a person to operate (office) lower extremity MRI equipment? Does a Radiology Technician certification authorize a person to operate a mobile fluoroscopic machine such as the Orthoscan Mobile DI?

NO. Podiatry Radiology Technician certifications are only for the performance of lower extremity X-rays (ionizing radiation) .... NOT for Magnetic Resonance Imaging.

With regard to a mobile fluoroscopic machine such as the Orthoscan Mobile DI ... the answer also is NO. Only a practitioner (defined as "doctor of medicine, osteopathy, podiatry, dentistry, or chiropractic who is licensed under the laws of this state [i.e. Texas] and who prescribes radiologic procedures for other persons for medical reasons") or MRT may operate this unit.

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  1. Health Care Fraud is a nationwide problem of theft from public (Medicare/Medicaid; taxpayer funded) and private health care systems. Where can I learn more about this type of white-collar crime & and it's monetary impact?

To report suspected "Medicare/Medicaid Fraud, Waste & Abuse" call toll free 1-800-HHS-TIPS (1-800-447-8477). This service is a product of the United States Department of Health & Human Services - Office of Inspector General.

Relating to preventing, detecting, and eliminating fraud, waste, and abuse ... on July 12, 2004 Governor Perry issued Executive Order RP-36 directing state agencies to increase enforcement efforts to fight fraud.

"On white-collar crime...", the Federal Bureau of Investigation (FBI) publishes a "Financial Crimes Report to the Public" which can be located HERE on the FBI's website.

The FBI is the primary investigative agency in the fight against HCF and has jurisdiction over both the federal and private insurance programs.

Additional information sourced from the FBI is as follows:

What is Health Care Fraud?: 1) Altered or fabricated medical bills and other documents. 2) Excessive or unnecessary treatments. 3) Billing schemes, such as: charging for a service more expensive than the one provided, charging for services that were not provided, duplicate charges, 4) False or exaggerated medical disability and 5) Collecting on multiple policies for the same illness or injury.

Health Care Fraud Schemes: HCF is carried out by many segments of the health care system using various methods. Some of the most prevalent schemes include:

Billing for Services not Rendered: These schemes can have several meanings and could include any of the following: 1) No medical service of any kind was rendered. 2) The service was not rendered as described in the claim for payment. 3) The service was previously billed and the claim had been paid.

Upcoding of Services: This type of scheme involves a billing practice where the health care provider submits a bill using a procedure code that yields a higher payment than the code for the service that was truly rendered. The upcoding of services varies according to the provider type. Examples of service upcoding include: 1) A routine, follow-up doctor’s office visit being billed as an initial or comprehensive office visit. 2) Group therapy being billed as individual therapy. 3) Unilateral procedures being billed as bilateral procedures. 4) 30-minute sessions being billed as 50+ minute sessions.

Upcoding of Items: A medical supplier is upcoding when, for example, the supplier delivers to the patient a basic, manually propelled wheelchair, but bills the patient’s health insurance plan for a more expensive motorized version of the wheelchair.

Duplicate Claims: A duplicate claim usually involves a certain item or service for which two claims are filed. In this scheme, an exact copy of the claim is not filed a second time; rather, the provider usually changes a portion, most often the date of service on the claim, so that the health insurer will not realize the claim is a duplicate. In other words, the exact claim is not filed twice, but one service is billed two times, in an attempt to be paid twice for one service.

Unbundling: This is the practice of submitting bills in a fragmented fashion in order to maximize the reimbursement for various tests or procedures that are required to be billed together at a reduced cost. For example, clinical laboratory tests may be ordered individually, or in a “panel” (i.e., a lipid panel, an arthritis panel, a hepatitis panel). Billing tests within each panel as though they were done individually on subsequent days is an example of unbundling.

Excessive Services: These schemes typically involve the provision of medical services or items which are in excess of the patient’s actual needs. Examples of excessive services include: 1) A medical supply company delivering and billing for 30 wound care kits per week for a nursing home patient who only requires a change of dressings once per day. 2) Daily medical office visits conducted and billed for when monthly office visits would be more than adequate.

Medically Unnecessary Services: A service is medically unnecessary and may give rise to a fraudulent scheme when the service is not justified by the patient’s medical condition or diagnosis. For example, a claim for payment for an electrocardiogram test may be fraudulent if the patient has no conditions, complaints, or factors which would necessitate the test.

Kickbacks: A health care provider or other person engages in an illegal kickback scheme when he or she offers, solicits, pays, or accepts money, or something of value, in exchange for the referral of a patient for health care services that may be paid for by Medicare or Medicaid. A laboratory owner and doctor each violate the Anti-Kickback Statute when the laboratory owner pays the doctor $50 for each Medicare patient a doctor sends to the laboratory for testing. Although kickbacks are often paid in cash based on a percentage of the amount paid by Medicare or Medicaid for a service, kickbacks may take other forms such as jewelry, free paid vacations, or other valuable items.

♦ Federal "Stark Law" information can be obtained HERE (Web) & HERE (PDF) from the Centers for Medicare & Medicaid Services (CMS). Section 1877 of the Social Security Act (42 U.S.C. 1395nn) is also known as the physician self-referral law and commonly referred to as the “Stark Law”. Information relating to a March 26, 2013 "Special Fraud Alert: Physician-Owned Entities" published by the United States Department of Health & Human Services - Office of Inspector General can be found HERE (PDF).

"Federal Stark Law / False Claims Act / Anti-Kickback Statute / Physician Self-Referral Law" Complaints. Such complaints should be filed directly to the: United States Department of Health & Human Services - Office of Inspector General

♦ Texas Anti-Solicitation laws can be found at Texas Occupations Code Chapter 102 "Solicitation of Patients" ... providing for administrative, civil and criminal penalties.

"Texas Anti-Solicitation - Solicitation of Patients" Complaints & "Deceptive Trade Practices" Complaints. Such complaints should be filed directly to the: Texas Attorney General's Office - Consumer Protection Division

♦ Board Rule §375.19 “Fees and Informed Consent” provides that: “(a) The podiatric physician has special knowledge which his patient does not have; therefore, to avoid misunderstanding he should advise his patient in advance of beginning treatment of the nature and extent of the treatment needed; the approximate time required to perform the recommended treatment and services; and any further or additional services or return by the patient for treatment, adjustments, or consultation and the time in which this shall occur. A podiatric physician should inform his patients as to the fees to be charged for services before the services are performed, regardless of whether the fees are charged on a case basis, on the basis of a separate charge for each service, or a combination of these two methods, or some other basis. If an exact fee for a particular service, as in extended care cases, cannot be quoted to a patient, a fair and reasonable estimate of what the fee will be and the basis on which it will be determined should be given the patient. (b) A podiatric physician shall not tender or receive a commission for a referral.” ♦ Board Rule §375.21(a) "Records" provides that: "All podiatric physicians shall make, maintain, and keep accurate records of the diagnosis made and the treatment performed for and upon each of his or her patients for reference and for protection of the patient for at least five years following the completion of treatment."

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  1. Can a Podiatrist sign a "Death Certificate" and "Pronounce Death"?

NO ... to both questions.  A Podiatrist in Texas is not authorized to sign a death certificate, not authorized to file one with the local or state registrar and not authorized to pronounce death.

 

Texas Health & Safety Code §191.024 “Reports of Information” provides that: “(a)  On the state registrar's demand, a person, including a local registrar, physician, midwife, or funeral director, who has information relating to a birth, death, or fetal death shall supply the information to the state registrar in person, by mail, or through the local registrar.  The person shall supply the information on a form provided by the department or on the original certificate. (b)  An organization or individual who has a record of births or deaths that may be useful to establish the genealogy of a resident of this state may file the record or a duly authenticated transcript of the record with the state registrar.”

 

If the state registrar makes a specific demand to a Podatrist or to any other “person” with knowledge to provide information, then that “person” would be required to do so. However, this statute does NOT allow, as a general matter, that the Podiatrist will be filing a death certificate.

Texas Health & Safety Code §193.002 “Death Records - Person Required To File” provides that: “The person in charge of interment or in charge of removal of a body from a registration district for disposition shall: (1) obtain and file the death certificate or fetal death certificate; (2) enter on the certificate the information relating to disposition of the body; (3) sign the certificate; and (4) file the certificate electronically as specified by the state registrar.”

A Podiatrist is NOT one of the “persons” that the law requires to file death certificates.

Furthermore, Texas Health & Safety Code §671.001 addresses who it is that determines and pronounces death.

Texas Health & Safety Code §671.001 “Standard Used In Determining Death” provides that: “(a) A person is dead when, according to ordinary standards of medical practice, there is irreversible cessation of the person's spontaneous respiratory and circulatory functions. (b) If artificial means of support preclude a determination that a person's spontaneous respiratory and circulatory functions have ceased, the person is dead when, in the announced opinion of a physician, according to ordinary standards of medical practice, there is irreversible cessation of all spontaneous brain function. Death occurs when the relevant functions cease. (c) Death must be pronounced before artificial means of supporting a person's respiratory and circulatory functions are terminated. (d) A registered nurse or physician assistant may determine and pronounce a person dead in situations other than those described by Subsection (b) if permitted by written policies of a licensed health care facility, institution, or entity providing services to that person.  Those policies must include physician assistants who are credentialed or otherwise permitted to practice at the facility, institution, or entity.  If the facility, institution, or entity has an organized nursing staff and an organized medical staff or medical consultant, the nursing staff and medical staff or consultant shall jointly develop and approve those policies.  The board shall adopt rules to govern policies for facilities, institutions, or entities that do not have organized nursing staffs and organized medical staffs or medical consultants.”

In Texas, the term “Physician” means only a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) licensed by the Texas Medical Board.

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  1. I am a newly licensed Texas Podiatrist … where can I get assistance in setting up my new practice?

Please contact the Texas Podiatric Medical Association (TPMA) at 512-494-1123 for assistance in new practice set-up.

Refer to the Examination Day “Memorandum” handout issued to you at Orientation.

Texas Occupations Code §202.262 “Display of License” provides that: “(a) A person licensed under this chapter must conspicuously display both the license and an annual renewal certificate for the current year of practice at the location where the person practices. (b) The person shall exhibit the license and renewal certificate to a Board representative on the representative's official request for examination or inspection.” (Note: The “Original” license and annual renewal certificate must be maintained/displayed at the license holder’s primary office location. A “Copy” of those documents is acceptable/valid for display in satellite offices and for the purposes of verifying licensure/registration for credentialing.)

Board Rule §375.9 “Consumer Information/Complaint Sign” provides that: “(a) In order for the public to be informed regarding the functions of the Board and the Board's procedures by which complaints are filed with and resolved by the Board, each licensee is required to display in each podiatric medical office information regarding the Board's name, address, and telephone number. (b) The licensee must display a sign furnished by the Board or provide to all patients and consumers a brochure that notifies consumers or recipients of services of the name, mailing address, and telephone number of the Board and a statement informing consumers or recipients of services that complaints against a licensee can be directed to the Board. (c) The sign shall be conspicuously and prominently displayed in a location where it may be seen by all patients. The consumer brochure, if chosen, must be prominently displayed and available to patients and consumers at all times.” (Note: “Complaint Signs” can be printed from the Board’s website at: www.tsbpme.texas.gov/complaint.htm.)

Board Rule §375.11 “Offices” provides that: “(a) It is an objective of the Podiatric Medical Practice Act and a policy of the Board that the public be properly informed concerning the availability and level of podiatric medical services in every community where a podiatric medical office is located. To accomplish this objective, a podiatric physician shall not establish or be affiliated with an office which does not comply with these sections. (b) All podiatric medical offices shall contain the minimum amount of treatment equipment and facilities so that the podiatric physician may provide his usual and customary podiatric medical services. (c) The office shall be attended by the podiatric physician on a routine schedule and frequently enough so that treatment is timely and convenient for the patients in the area where the office is located. (d) All offices shall be staffed or equipped so that patients and the public can conveniently determine when the podiatric physician will be in his office. Examples of how this information might be provided are an answering service or an automatic telephone listening and recording device of some type. (e) This section does not prohibit a podiatric physician from practicing in communities which are too small to economically justify or otherwise warrant the establishment of an office, but when a podiatric physician undertakes to practice in such communities, he must have sufficient staff and equipment or facilities available to provide safe treatment.”

Board Rule §375.21 “Records” provides that: “(a) All podiatric physicians shall make, maintain, and keep accurate records of the diagnosis made and the treatment performed for and upon each of his or her patients for reference and for protection of the patient for at least five years following the completion of treatment.” (Note: This is a minimum retention period.)

If you have a change of address or phone number, you must notify the Board in writing.  You may mail or fax this information to us or submit the change through our website at www.tsbpme.texas.gov, but please remember change of address or phone numbers will be NOT taken over the phone.  We will mail all correspondence to your last known address. Be advised that Board Rule §375.27 “Report Change of Practice Address and/or Phone Number to the Board” provides for a penalty for failure to report a change of address.

Pursuant to Board Rule Chapter 373 “Advertising and Practice Identification,” submit your Advertisements/Practice Identifications/Trade Names to the Board’s Executive Director for review/approval at: www.tsbpme.texas.gov/contact.htm. The Board approves Practice/Trade Names from the standpoint that the name remains within the advertising scope of practice for podiatry. The final registration and utilization of any Board (scope) approved name rests upon the civil jurisdiction of the local County Clerk's office or the Texas Secretary of State. Additionally, with regard to "Advertising" in general and proper identification of a licensee's practice as being one of "Podiatry," each podiatric physician shall publish his/her own name and professionally identify himself/herself (i.e. DPM, Podiatrist, Etc.). The purpose of the Board's "Advertising" rules and of so limiting the professional designations of a podiatric physician and his/her practice's business is to ensure that the public and all prospective patients are reasonably informed of the distinction between podiatric physicians and other medical practitioners as is reflected by the difference in training and licensing, and the scope of practice.

Radiology Technicians: All persons who take x-rays in your office must be registered with the TSBPME as a “Radiological Technician.” Registration information may be obtained from the Board’s website at:  www.tsbpme.texas.gov/radiologytechnicians.htm

X-Ray Machines/Equipment: Every Podiatric Physician’s office/practice is to have their X-ray machine registered with the Texas Department of State Health Services “Radiation Control Program.” DSHS Radiation Control Inspectors/Investigators travel the state to ensure the safety of X-ray machines and to also ensure that staff operating such machines are appropriately trained (as evidenced by the DSHS “Registry” or NCT/PMA training certificate) and ultimately registered with the TSBPME as a "Podiatric Medical Radiological Technician" if performing Podiatric “Foot/Ankle” X-rays in a Podiatric Physician’s office/practice. Again, Podiatric Physician office/practice NCT’s / PMA's must evidence their DSHS training and ultimate registration with the TSBPME as a "Podiatric Medical Radiological Technician" should they be asked by a DSHS Inspector/Investigator. X-Ray machine/equipment registration information may be obtained from the DSHS website at: www.dshs.state.tx.us/radiation/default.shtm

Controlled Substances: Visit the Board's "Prescription Information" webpage to obtain additional information on changes to the Texas Prescription Program, Ordering Controlled Substances Prescription Pads, Registering for the New Prescription Drug Monitoring Program Database, Abuse/Misuse of Prescriptions/Pain Medications & Drug Diversion Prevention,  Controlled Substances Schedule Changes and all other information related to Prescriptions/Controlled Substances.

Hyperbaric Oxygen (HBO) Registration: To obtain a HBO registration, please visit our website at the following for additional information: www.tsbpme.texas.gov/qa.htm#q13  & www.tsbpme.texas.gov/agencydocuments/HBO%20Application.pdf.

Nitrous Oxide (N2O) Registration: To obtain a N2O registration, please visit our website at the following for additional information: www.tsbpme.texas.gov/qa.htm#q26 & www.tsbpme.texas.gov/agencydocuments/Nitrous%20Oxide%20Application.pdf.

Additional Resource Information:

Check your local (city/county) building codes. Most are specific for medical offices.

Contact your malpractice carrier or an attorney for input.

American Podiatric Medical Association: http://www.apma.org/

Texas Podiatric Medical Association: http://www.txpma.org/

Centers for Medicare & Medicaid Services: http://www.cms.gov/

Texas Medicaid: http://www.hhsc.state.tx.us/about_hhsc/index.shtml

National Board of Podiatric Medical Examiners: http://www.nbpme.info/

Federation of State Medical Boards: https://www.fpmb.org/

U.S. Occupational Safety & Health Administration: http://www.osha.gov/

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  1. Where can I get information on what services are covered and not-covered for “Medicare Podiatry Services”?

The Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health & Human Services publishes a “Fact Sheet” that has responsive information. Because this information changes, as well as the related CMS website links, we recommend that you simply Google “Medicare Podiatry Services Fact Sheet” and look for publications from www.cms.gov.

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  1. Can a Podiatrist administer the "Flu Shot"?

No. The "Flu" is not a disease, disorder, physical injury, deformity, or ailment of the human foot.

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  1. Are "Telemedicine & Telehealth" authorized for the practice of Podiatry in Texas?

No. Texas Occupations Code Chapter 202 (Podiatry Practice Act) does NOT permit/allow "Telemedicine/Telehealth" in any capacity for Podiatry in Texas. As per current state law, only "Physicians" (i.e. MD/DO and their extenders) licensed by the Texas Medical Board are permitted to engage in "Telemedicine/Telehealth" pursuant to Texas Occupations Code Chapter 111, the Texas Medical Board (MD/DO) Rules Chapter 174 and Texas Insurance Code Chapter 1455.

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