59 and X- Modifier Advocacy Update: Anthem Victory; APMA, CMS Meet | News

August 30, 2021

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, 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.

While commercial plans, Medicaid, and Medicare Advantage plans may set their own coding policy, many follow Medicare’s National Correct Coding Initiative (NCCI). In July, APMA wrote to CMS requesting that NCCI update its 59 Modifier policy, and last week APMA met with CMS and NCCI officials. For more information, visit www.apma.org/59toolkit.

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August 30, 2021

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