In addition to the general requirements in §354.1001 of this title (relating to Claim Information Requirements), the following information is required on claims for podiatry services:
  (1) place of service;
  (2) the type of each diagnostic, treatment, or surgical procedure;
  (3) the number of miles for which a travel charge is made;
  (4) the individual charge for each service;
  (5) diagnosis(es) of the condition(s) for which treatment and services were provided. With respect to diagnostic or other services furnished at the request of a physician or another podiatrist, this requirement may be waived by the health insuring agent if the podiatrist providing the services shows that such information is not available to him or her;
  (6) name, address, and appropriate identification number of the ordering physician or podiatrist if services were provided by a non-ordering podiatrist; and
  (7) all supplemental information, including clarification of the diagnoses in terms of the degree or extent of involvement, necessary to substantiate the need for the services provided or changes made, or both.

Source Note: The provisions of this §354.1101 adopted to be effective May 30, 1977, 2 TexReg 1929; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective September 1, 2003, 28 TexReg 7287; amended to be effective August 6, 2013, 38 TexReg 4886