New CPT Code Set
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.
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APMA Summary of MPFS
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.
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Opposing CMS Efficiency Adjustment
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.
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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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