CMS Withdraws Skin Substitute LCDs
CMS announced that A/B Medicare Administrative Contractors (MACs) are withdrawing the Local Coverage Determinations (LCDs) for Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers. These LCDs were scheduled to take effect on January 1, 2026. With the withdrawal of these LCDs, there are no changes to skin substitute coverage for Part B Medicare beneficiaries in the new year.
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APMA Meets With Aetna
APMA advocacy staff met with Aetna leadership as part of APMA's ongoing quarterly discussions with the insurer. The conversation focused on prior authorization, documentation and coding oversight, and emerging coverage policies relevant to podiatric physicians.
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Administrative Burdens for Diabetic Shoes
APMA leadership and staff met with officials from CMS, including representatives from the Center for Clinical Standards and Quality and the Center for Program Integrity, to discuss access barriers related to therapeutic shoes for persons with diabetes (TSD). APMA highlighted concerns that current DME MAC requirements for therapeutic shoes are overly burdensome and go beyond what is required under Medicare statute: This ultimately results in significant delays and reduced access for beneficiaries.
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New Skin Substitute Resource Page
Members can find all the information related to skin substitutes coverage and payment on APMA’s new Skin Substitute Resource Page, which includes detailed videos covering the changes, the most current information on the future effective LCDs (and related coding and billing articles), information on the WISeR Model, and more. The most recently recorded video (Skin Substitute Policies Scheduled to Take Effect January 1, 2026) will be updated once the MACs have released final data.
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Interstate Podiatric Medical Licensure Compact
APMA is pleased to announce its formal endorsement of the Federation of Podiatric Medical Board’s (FPMB) initiative, the Interstate Podiatric Medical Licensure Compact. Following a vote by the APMA Board of Trustees, APMA submitted a support letter to the FPMB, affirming the APMA’s commitment to advancing this important licensure modernization initiative.
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New York Enacts Modernized Scope of Practice Law
New York has officially enacted a modernized scope of practice law for podiatric physicians that was championed by the New York State Podiatric Medical Association (NYSPMA). This marks a major milestone for podiatrists across the state and represents years of sustained advocacy by NYSPMA leadership and members. This law aligns statutory authority with podiatric education and residency training and ensures that podiatrists can continue to practice at the top of their license.
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A Statement from APMA on Board Certification for Credentialing / Privileging and CAQs
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.
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New On-Call Reimbursement Resources
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.
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MATE Act Fix Is Law
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.
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Opposition to Elevance Proposal
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.
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Prior Authorization Advocacy Update
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.
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Skin Substitute Provisions Correction
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.
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