APMA is the gold standard in foot and ankle coding education and resources. With the latest news, new and archived educational programs, and indispensable tools, your association has you covered. Questions? Contact coding.hpp@apma.org.
Upcoming Live Coding Education Opportunities
- Webinar: Radiology Services: Coding and Documentation (April 14, 2026 / 8:00-9:00 p.m. EDT)
Jeffrey D. Lehrman, DPM, CPC, will provide APMA members with a refresher on appropriately coding and documenting radiology services. Sponsored by Officite.
Coding Updates:
Educational Resources:
Coding Issue by Topic (alphabetical)
Durable Medical Equipment (DME)
- Same or Similar Resources
APMA has created a resource page addressing the ongoing issues related to the Same or Similar policy. Most recently added to the page is series of short instructional videos to help guide members on how to prevent or lower the chances of experiencing denials related to DME, presented by Paul Kesselman, DPM, and Jordan Stewart, DPM.
- RT and LT Modifier Usage Change
There are unique guidelines related to use of these modifiers when submitting claims for ankle-foot orthoses, knee-ankle-foot orthoses, lower limb prostheses, surgical dressings, orthopedic footwear, and therapeutic shoes for persons with diabetes.
- L3000 Coverage Alert
APMA has received several recent queries regarding coverage of foot orthotics (L3000–L3060) under Medicare. Medicare's coverage on foot orthotics is extremely limited, making it unlikely that most podiatrists will ever provide foot orthotics meeting Medicare's coverage criteria.
Evaluation and Management (E/Ms)
Lymphedema
New Codes For Lymphedema Compression
Since January 1, 2024, Medicare covers ready-to-wear, gradient compression garments for the treatment of lymphedema, including in the absence of an open ulcer.
Modifiers
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-25 Modifier
Proper Use of -25 Modifier
Appropriate use of the 25 modifier is essential. There has recently been an uptick in payers proposing and/or implementing edits that deny payment of Modifier 25 when submitting an evaluation and management (E/M) service with a procedure. These payers are using incorrect utilization and inadequate documentation to support these edits and denials.
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-59 Modifier
59 Modifier Toolkit
Created to help members with billing routine foot care using the -59 modifier, members can find template letters, articles, infographics, and webinars on this resource page.
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JW / JZ Modifiers
When providers discard any portion of a single-use vial or single-use package after administering a drug or biological to a Medicare patient, they must use the JW Modifier to indicate the quantity discarded.
Patient Relationship Categories and Codes (PRCs)
- Patient Relationship Categories and Codes (PRCs) Explained
CMS has developed Patient Relationship Categories and Codes (PRCs) to allow providers to self-identify their relationships with patients. As the Cost performance category for the Merit-based Incentive Payment System (MIPS) evolves, and the stakes associated with MACRA rise, it is important for providers to establish the nature of their relationships with their patients and their degree of responsibility for each patient’s care. APMA recommends that members use these currently voluntary codes. Their use may become mandatory.
Prescription Drug Management Reminder
APMA urges members to consider key points when using “prescription drug management” to satisfy the “Moderate” threshold of the “Risk of Morbidity from Additional Diagnostic Testing or Treatment” element of evaluation and management (E/M) level selection.
Remote Physiological Monitoring (RPM)
- Remote Physiologic Monitoring
Remote Monitoring of Physiologic Parameters involves dispensing a device to a patient that is capable of monitoring certain physiologic parameters, providing the transmission necessary for the provider to monitor the feedback from that device, reviewing the feedback provided by that device, and communicating with the patient, when necessary, regarding the results of that feedback.
- OIG To Review Remote Patient Monitoring
The US Office of the Inspector General (OIG) has announced its plan to review Medicare fee-for-service claims and Medicare Advantage encounter data for remote patient monitoring services.
Routine Foot Care (also known as At-Risk Foot Care)
- At-Risk Nail and Callus Care
This infographic demonstrates the proper use of -59 and -X{ESPU} modifiers with at-risk foot care.
- Routine Foot Care and -59 Modifier Claims Tool Kit
The Health Policy and Practice Committee (HPPC) formed a workgroup to address problematic payment policies related to the -59 modifier and routine foot care.
- Routine (At Risk) Foot Care Flow Chart
Your APMA Coding Committee created this flow chart to help members choose appropriate coding when performing routine (at risk) foot care. The chart differentiates between trimming and debriding and the appropriate codes that accompany each.
- “Date Last Seen” Guidance Updated
The Part B MAC at-risk foot care coverage policies list certain requirements related to systemic diagnoses that may play a role in coverage of at-risk foot care.
Skin Substitutes
Steroids
Significant Changes to Steroid HCPCS Coding
Effective April 1, 2024, HCPCS J1020, J1030, and J1040 have been deleted from the HCPCS code set, which is managed by CMS. A new code, HCPCS J1010, was added to replace these deleted codes. (J1010-Injection, methylprednisolone acetate, 1 mg).
Surgical Treatment of Nails
Surgical Treatment of Nails Policy
CMS has implemented a policy, apparently on a national level, concerning the surgical treatment of nails. This policy establishes utilization parameters regarding the use of CPT® 1 11730, 11732, and 11750.
Unbundling
Coding Update on Unbundling
CPT codes should be selected based only upon choosing the code(s) that most accurately reflect the service(s) provided.