APMA Working for You in 2023: Advocacy Victories | APMA
APMA Working for You in 2023: Advocacy Victories

APMA celebrated many major advocacy accomplishments protecting and enhancing podiatric medicine in 2023 and 2022!

Alabama Scope of Practice Modernized to Include the Ankle

APMA is thrilled to announce that the Alabama Podiatric Medical Association (ALPMA) succeeded in its long-term efforts to modernize the Alabama scope of practice statute. Alabama Governor Kay Ivey (R) signed Senate Bill 28 into law on May 3, updating podiatrists’ scope to include the ankle, effective on August 1.

APMA’s Center for Professional Advocacy (CPA) has worked tirelessly with ALPMA to bring about this exciting victory on behalf of our mutual members. This work took root nearly a decade ago at an APMA summit for the then-four states whose scope-of-practice laws did not allow podiatrists to treat the ankle. Since that time, South Carolina also has been successful in modernizing its scope bill, leaving only our colleagues in Massachusetts and Mississippi without ankle privileges. APMA continues to do battle for its members in those states, supporting the efforts of our component societies to bring their scope laws current with the education, training, and experience of today’s podiatrist. ALPMA is an outstanding example of what our members can accomplish together when they commit to the years of effort that go into effecting legislative change.

Aetna Routine Foot Care Claims Victory

Aetna has informed APMA that effective July 23, it will drop its external review program regarding use of -59 Modifier when submitted with CPT 11719-11721, G0127, and 11055-11057.

This development follows more than two years of APMA’s advocacy through multiple communications and meetings with Aetna leadership.

Aetna had been inappropriately applying an edit to certain foot care claims. APMA’s Health Policy Committee formed a 59 Modifier workgroup more than two years ago to address this issue. Thanks to the work of that group, other APMA members, staff, and consultants all contributed to this latest victory.  

APMA encourages members to continue to follow NCCI guidelines and only submit callus paring codes when the calluses pared are not on the same distal phalanx of a toe that had a nail debrided. Members can learn more about how to lower the chances of denials related to the 59 Modifier by reviewing APMA’s -59 Modifier Claims Tool Kit.

CMS Surgical Treatment of Nails Victory - 11750

After multiple meetings with APMA representatives, CMS is now allowing medically reasonable and necessary repeat submissions of CPT® 11750 for the same toe without the need to submit for redetermination. The Novitas and First Coast Service Options Surgical Treatment of Nails Billing and Coding Local Coverage Articles instruct providers to report modifier KX for a medically reasonable and necessary repeat nail excision (CPT 11750) on the same toe. In this situation, the medical record must be specific as to the indication, such as ingrown nail of the opposite border or new significant pathology on the same border recently treated. Noridian, CGS, and Palmetto have shared that they are not mirroring the Novitas and FCSO guidance regarding the KX modifier for medically necessary repeat nail excisions. Visit www.apma.org/SurgicalNail for additional resources and updates.

Another Legislative Victory for DPMs

APMA is pleased to achieve victory on HR 2545, a bill to further clarify the role of doctors of podiatric medicine in the Department of Veterans Affairs. The bill was designed to address an oversight in the MISSION Act passed in 2018. That bill updated the pay authority for DPMs to be the same as that of their MD/DO colleagues but neglected to cover the position of Director of Podiatric Services. With the passage of this bill, the director’s title will be changed to Podiatric Medical Director, and the position will be placed in the same pay authority as other medical director positions at the VA Central Office. With the passage of this bill, the VA will fully recognize and treat all DPMs within the Veterans Health Administration as physicians. APMA gratefully acknowledges the support of Rep. Brad Wenstrup, DPM (R-OH), and Rep. Frank Mrvan (D-IN) for their leadership in sponsoring the bill and ushering it through the House of Representatives. The companion bill, S 2787, introduced by Senator Bill Cassidy (R-LA) on September 21, 2021, was passed by the Senate VA committee on 12/15/21, and is expected to be passed by the full Senate when it returns from recess in early February.

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.

President Signs Medicare Fix Legislation 

President Biden signed S 610, Protecting Medicare and American Farmers from Sequester Cuts Act, on Friday, December 10, 2021. This legislation, among other things, prevents the looming fiscal cliff in Medicare reimbursement for physicians. APMA joined AMA and other members of the MD/DO community to support this legislation. The signed bill, which received bipartisan support in Congress, makes the following adjustments to Medicare reimbursement:

  • Provides a three-month delay of the Medicare sequestration reductions and a three-month, one-percent reduction in Medicare sequestration payment reduction
  • Provides a one-year increase in the Medicare physician fee schedule of 3 percent to support physicians and other health professionals in adjusting to changes in the Medicare physician fee schedule during 2022
  • Prevents Statutory PAYGO sequestration through 2022, preventing automatic across-the-board cuts to Medicare, farm programs, social services, student loans, and resources for students and individuals with disabilities, among other programs

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.

New Guidance on Surgical Treatment of Nails for Those Whose Serve Novitas and First Coast Beneficiaries 

Medicare Contractors Novitas and First Coast Services released identical policies that take effect January 30, 2022. The policies state:

  • Providers must document which nail borders are addressed when surgical treatment of nails is performed.
  • When surgical procedures (CPT 11730, 11732, 11750, 11765) are performed on the medial and lateral borders of the same toenail, a separate code should not be submitted for each border.
  • A repeat nail avulsion on the same toe less than eight months following a previous avulsion is allowed if the ingrown nail affects the opposite border of the one recently treated or there is new, significant pathology affecting the same border recently treated.
  • A repeat nail excision (CPT 11750) of the same toe is allowed if the procedure involves the opposite border of the one already excised or there is new, significant pathology affecting the same border already treated.

VICTORY! Anthem to Fix At-Risk Foot Care and -59 Modifier Coding Policy

Anthem has agreed with APMA's recommendation to fix its At-Risk Foot Care and -59 Modifier Coding Policy. In a recent meeting, Anthem representatives stated the new policy permits paring of calluses (CPT 11055-11057) and debridement of a toenail (CPT 11720/11721) when performed on the same toe if the pared callus was unrelated to and not contiguous with the debrided nail and the callus paring and nail debridement were distinct, unrelated procedures, even when performed on the same toe. This policy became effective on July 25, 2021, and the change affects commercial plans, Medicaid, and Medicare Advantage Plans.

APMA thanks Anthem for listening to our members' concerns and collaborating with APMA on this important and necessary change.

APMA also reached out to Centene and Humana about this issue, and will continue to advocate for our members. 

Parity 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 long-standing 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.

Huge Victory for Noridian Medicare Providers and Patients

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.

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/COVIDvaccinators.

To learn more about APMA's earlier advocacy efforts, download the handout of APMA’s 2020–2021 advocacy wins and the handout of APMA’s 2020 advocacy wins!

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