Anthem Potentially Penalizing Hospitals
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.
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Peripheral Nerve Block LCD
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.
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CAC-PIAC Meeting
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.
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WISeR Model Update
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.
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CAC-PIAC Meeting
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.
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Revise the WISeR Model
APMA continues its strong opposition to the CMS WISeR Model. Last week, APMA directly contacted the Center for Medicare and Medicaid Innovation, calling on CMS to remove CPT® 11042 (Debridement subcutaneous tissue, first 20 square cm) from Appendix B of the WISeR Model Provider and Supplier Operational Guide.
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New Video on WISeR Model
APMA Health Policy Advisor Jeffrey Lehrman, DPM, CPC, recorded an extended video detailing new information available from CMS on the Wasteful and Inappropriate Service Reduction (WISeR) Model. Dr. Lehrman outlines several aspects of the WISeR Model, including its objectives, the timeline for implementation, and the impacted states.
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Redesigned eAdvocacy Hub
APMA has redesigned its eAdvocacy Action Center to make it easier than ever for members, patients, and students to engage in grassroots advocacy. The updated platform empowers APMA members to quickly engage their members of Congress and influence federal health policy. It also provides tools to take action on critical state legislation.
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LCDs on Peripheral Nerve Blocks
Five of seven Medicare Administrative Contractors (MACs) have proposed Local Coverage Determinations (LCDs) that would restrict coverage for peripheral nerve blocks (PNBs). APMA has coordinated a national response to protect access to these essential services. Impacted MACs include CGS, NGS, Noridian, Palmetto, and WPS.
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Claims Holds Lifted
Note to APMA members that received the October 21 Weekly Focus: Shortly after the Weekly Focus was finalized, CMS updated its guidance and lifted most claims holds. The claims hold has now been lifted for claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and Federally Qualified Health Center (FQHC) claims.
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Diabetic Shoe Policy
APMA partnered with 17 other societies representing providers, patients, and suppliers to send a letter to all four DME MACs requesting that they revise "Therapeutic Shoes for Persons with Diabetes – Policy Article" (A52501). The goal is to restore beneficiary access to this important Medicare benefit.
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