APMA Working for You in 2021: Advocacy Victories | APMA
APMA Working for You in 2021: Advocacy Victories

APMA celebrated many major advocacy accomplishments protecting and enhancing podiatric medicine in 2021. Download the handout of APMA’s 2021 advocacy wins!

COVID-19 Relief Legislation Includes Victories for Podiatrists

APMA has been aggressively advocating for podiatric physicians and surgeons in COVID-19 relief legislation since the early days of the pandemic. In late December, Congress passed a $900 billion COVID relief package. As a result of APMA’s efforts, the bill includes significant victories for podiatry. The bill provides for a one-time, one-year, 3.75-percent increase in the Medicare Physician Fee Schedule to provide relief during the COVID-19 public health emergency. With this increase and other changes included in the legislation, podiatry is expected to see an overall 5-percent increase in Medicare reimbursement in 2021 rather than an expected 1-percent decrease.

Visit www.apma.org/COVID19 for all of APMA's COVID-19 resources.

Victory! Palmetto to Reimburse DPMs for RPM Services

As a result of the efforts of APMA, DME Workgroup, and podiatric CAC representatives for Palmetto jurisdictions, Palmetto will now reimburse DPMs for performing remote physiological monitoring (RPM) services. In a letter to the Palmetto medical directors, APMA reminded Palmetto that these services are well within the scope of practice of podiatric physicians, and arbitrarily restricting podiatric physicians’ ability to perform these services limits Medicare beneficiaries’ access to services that can help prevent diabetic foot ulcers. Reimbursement for these services to podiatrists is retroactive to January 2020, but podiatrists must resubmit their claims. Members should contact their CAC representative if they encounter any problems. READ MORE

Victory! TRICARE Regulations Updated to Allow DPMs to Refer for PT/OT Services

TRICARE released a final rule fixing its outdated regulations to allow DPMs to refer TRICARE patients to Physical Therapy and Occupational Therapy Services (PT/OT) as well as speech pathology. The enforcement of the rule caused significant issues for podiatrists and their patients because podiatrists had to send patients back to their primary care provider for a referral. To fix this outdated rule, the APMA Health Policy and Practice department engaged in advocacy efforts that included direct conversations and letters with the Department of Defense (DOD) officials and worked with APMA’s Legislative Advocacy department to obtain support from Rep. Brad Wenstrup, DPM (R-OH). READ MORE

Biden Signs Bill Delaying Medicare Sequester Cuts Through End of 2021

APMA is pleased to report that President Joe Biden has signed into law legislation from Congress that will delay resumption of the Medicare sequestration cuts through the end of 2021. CMS had previously instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow, anticipating congressional action. APMA thanks all members who participated in the eAdvocacy campaign to contact the US House representatives to request that these automatic cuts be delayed. READ MORE

DPMs May Order Non-Invasive Vascular Arterial Studies for TRICARE Patients

In an April 22 meeting, HeathNet Federal Services (HNFS), the TRICARE administrator for the West Region, agreed to APMA’s previous request, and now permits podiatrists to order non-invasive vascular or arterial studies for TRICARE beneficiaries. Prior authorization is not required, but HNFS recommends podiatrists request an authorization through its provider portal to ensure the service will not be denied. In emergency situations, HNFS recommends that podiatrists call HNFS for the authorization. APMA still takes issue with the policy manual exclusion and is again reaching out to the Defense Health Agency to remove the exclusion altogether from the TRICARE program. READ MORE

CPT Win for Novitas Providers

In 2019, three new CPT® codes were released (CPT 20932–20934) that deal with allograft use. Novitas, a Medicare Administrative Contractor (MAC) responsible for 11 states and Washington, DC, did not allow payment to podiatrists when these codes were submitted. Following an initiative led by Maryland and DC region Carrier Advisory Committee (CAC) Representative David Freedman, DPM, Novitas has now updated its procedure file to allow payment to all podiatrists for these codes. READ MORE

VICTORY! NCCI Updates Policy Manual for Medicare, Use of -59 Modifier!

As a result of APMA’s advocacy efforts, the National Correct Coding Initiative (NCCI) updated Chapter I of the NCCI Policy Manual for Medicare Services in Section E.1.d.(3), Example #2, to reflect a prior determination by CMS specifying that use of Modifier 59 or X[ESPU] is acceptable if the procedures described by CPT® 11720 and 11055 are conducted on lesions that are anatomically separate from one another—even if on the same digit. This victory ensures the NCCI Policy Manual language is consistent throughout and accurately reflects CMS policy.

Major Victory for First Coast Providers

For many years, providers with First Coast Service Options Inc., the Medicare administrative contractor for jurisdiction N, which includes Florida, Puerto Rico, and the US Virgin Islands, were required to list the MD, DO, PA, or NP who diagnosed a non-asterisked complicating condition that qualified a patient for routine foot care coverage. Thanks to advocacy efforts led by Florida Podiatric Medical Association CAC Representative Mark Block, DPM, First Coast has reversed this longstanding policy in an updated Local Coverage Article by allowing podiatrists to serve as providers who diagnose a non-asterisked complicating condition that qualifies a patient for routine foot care coverage. READ MORE

Huge Victory for Noridian Medicare Providers and Patients

In the summer of 2020, Noridian released a Routine Foot Care Billing and Coding Local Coverage Article (LCA) that contained diagnosis codes eligible for use with covered routine foot care services. APMA and its members providing care to patients in Noridian’s network felt this list of diagnosis codes was inadequate. Following APMA’s advocacy efforts, including a letter to Noridian Healthcare Solutions, LLC, meetings with CMS and Noridian’s carrier medical director, and APMA Coding Committee follow-up and coordination, a new LCA has been released, which contains 353 added diagnosis codes that APMA requested. READ MORE

Biden Administration Authorizes DPMs, Students to Administer COVID-19 Vaccine

Under President Biden’s direction, the US Department of Health and Human Services (HHS) expanded the class of medical professionals and health-care students who may serve as vaccinators to include licensed doctors of podiatric medicine, recently retired podiatric physicians, and podiatric medical students. APMA has been advocating to include DPMs and students in the pool of professionals who can serve as vaccinators at both the state and federal level, including writing to the National Governors Association, assisting state components, and meeting with HHS. The Biden administration also launched an online vaccinator portal for providers and students to determine eligibility and find vaccination management sites; for more information, visit www.PHE.gov/COVIDvaccinatorsREAD MORE

To learn more about APMA's earlier advocacy efforts, download the handout of APMA’s 2020 advocacy wins!

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