APMA recognizes and relies on the rigorous certification processes established by the two recognized boards, the American Board of Foot and Ankle Surgery (ABFAS) and the American Board of Podiatric Medicine (ABPM). Board certification signifies that a podiatrist has demonstrated a cognitive knowledge of a defined area of practice. However, in the context of credentialing and privileging, APMA firmly maintains that board certification must not be the sole criterion for determining hospital privileges or for membership in managed care or other health-care organizations.
APMA has created a resource page to help members navigate the evolving expectations and compensation models surrounding on-call responsibilities. Resources include guidance, data, and practical tools. APMA recognizes the on-going challenges for members related to unpaid on-call services, and we are actively looking to support members here.
The APMA-endorsed SUPPORT for Patients and Communities Reauthorization Act of 2025 (HR 2483) has been signed into law. As a direct result of APMA's advocacy efforts, the bill included a technical fix to the DEA Medication Access and Training Expansion (MATE) Act, which allows podiatry organizations to provide mandatory training on the treatment and management of patients with substance use disorders.
Last week, APMA expressed its significant concerns and opposition to a recently announced Elevance proposal that will penalize hospitals in 11 states with a 10 percent reimbursement reduction when out-of-network physicians are used in the provision of care at in-network hospitals.
APMA continues its strong advocacy against CMS' Wasteful and Inappropriate Service Reduction (WISeR) Model. APMA recently endorsed the Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act that would prohibit implementation of the WISeR Model and prevent the expanded use of prior authorization in fee-for-service Medicare. APMA previously endorsed the bill's House counterpart (HR 5940) as well.
On November 28, CMS published a correction notice to the CY 2026 Medicare Physician Fee Schedule (MPFS), which included updates to the finalized payment rate for skin substitutes. CMS clarified that it is finalizing a CY 2026 payment rate of $127.14 per square cm, aligning with the Hospital Outpatient Prospective Payment System (OPPS) rate in the preamble discussion.
APMA is deeply concerned by recent OIG reports addressing podiatrists’ claims for E/M services billed with modifier 25 and podiatrists' routine foot care claims. The reports make sweeping claims regarding podiatrists’ compliance that fail to recognize the value of care delivered by our profession and are not reflective of care delivery and claims billing today.
Effective January 1, 2026, the SC Modifier must be appended to all lymphedema compression treatment item claims submitted to the DME MACs when all of the statutory and reasonable and necessary requirements outlined in the Lymphedema Treatment Act regulations have been met.
The deadline for call for speakers for the APMA 2026 Annual Scientific Meeting (The National) is December 5. The conference will take place August 6–9 at the Gaylord Opryland Resort & Convention Center in Nashville, TN. Broad topic areas include surgery, biomechanics, dermatology, complications, wound care, and trauma; however, any topic related to foot and ankle care will be considered.
APMA has created new resources (25 Modifier Toolkit and E/M Resources page) related to billing claims that include an E/M service with the –25 modifier, with a focus on the management component. DPMs are the third highest user of the –25 modifier, and public, private, and commercial payers continue to scrutinize its use.
As a member of the Regulatory Relief Coalition (RRC), APMA joined 18 national physician and health-care organizations in a letter to CMS urging continued reforms to improve transparency and reduce administrative burden in the Medicare Advantage (MA) prior authorization process.The letter also voiced support for the bipartisan Improving Seniors Timely Access to Care (Seniors') Act.
On November 21, the Centers for Medicare and Medicaid Services (CMS) released final policies affecting payment for Medicare hospital outpatient department services for calendar year (CY) 2026. Specifically, CMS finalized that skin substitute products in sheet form would be treated as separately payable incident-to supplies under the Medicare Hospital Outpatient Prospective Payment System (OPPS).
A new CPT® code set takes effect January 1, 2026, containing additions, deletions, and modifications. Some of those changes that are most pertinent to podiatrists include codes related to remote physiologic monitoring, real-time fluorescence wound imaging, enzymatic debridement of burns, limb lengthening, and remote therapeutic monitoring.
CMS released the CY 2026 MPFS Final Rule. Due to the advocacy efforts of APMA and its members, the final MPFS includes an increase in the conversion factor (CF) for 2026 that is largely driven by a 2.5 percent payment increase passed by Congress in the One Big Beautiful Bill. In total, podiatrists are estimated to see an increase in total Medicare payments of more than 4 percent for 2026.
APMA partnered with other medical specialty societies to urge Congress to stop CMS from implementing an "efficiency adjustment" in the MPFS. The "efficiency adjustment" reduces the work RVUs and intra-service time for all non-time-based codes by 2.5 percent in 2026.
Elevance Health (formerly known as Anthem) recently shared plans to potentially penalize hospitals and other contracted facilities that use care providers who are not in-network with its Anthem Blue Cross Blue Shield commercial plans. This policy is scheduled to take effect on January 1, 2026.
APMA submitted its formal opposition to a problematic proposed LCD that would significantly restrict coverage of peripheral nerve blocks (PNBs). APMA urged five MACs to rescind the policies as proposed and recommended changes if recission was not possible.
APMA's 25th Annual Joint National CAC-PIAC Meeting convened virtually on Friday, November 14, drawing representatives from across the country for a full day of education, collaboration, and problem-solving on the evolving payer landscape.
APMA partnered with the American Society of Anesthesiologists (ASA) and other medical societies to commend members of the House Appropriations Committee for passing an amendment by Representative Lois Frankel (D-FL) to the FY2026 House Labor, Health and Human Services, and Education Appropriations bill that would restrict funding for the WISeR Model.
The 25th Annual Joint National Contractor Advisory Committee and Private Insurance Advisory Committee Representatives (CAC-PIAC) will take place on Friday, November 14, in the Washington, DC, area. Sessions will explore Medicare policy outlook for 2026 and beyond, compliance and documentation best practices for skin substitutes, skill-building workshops, and other legislative and regulatory updates.