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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APMA Statement on OIG Reports on Podiatrists’ Claims
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.
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Lymphedema Compression Items
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.
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Call for Speakers for The National 2026
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.
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Resources on –25 Modifier
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.
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MA Prior Authorization
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.
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Skin Substitute Payment
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).
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