Regence BlueShield Withdraws Modifier 25 Policy
APMA’s strong, sustained advocacy stopped a concerning Regence BlueShield Modifier 25 reimbursement policy from taking effect. After APMA raised significant concerns and actively pressed Regence to reconsider the change, Regence announced that it will not implement the policy, which had been scheduled to take effect September 1.
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VA Clarification for Podiatric Physicians
APMA recently sought clarification from the Department of Veterans Affairs (VA) regarding how its revised Community Provider Standard for Orthotic, Prosthetic, and Pedorthic Devices (OPPD) applies to podiatric physicians.
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Proposed Modifier 25 Cuts
Today, APMA President Patrick DeHeer, DPM; APMA CEO Meghan McClelland; and members of the APMA advocacy team met directly with Centers for Medicare & Medicaid Services (CMS) officials to urge the agency to withdraw its proposed 50 percent payment cut for certain same-day services reported with Modifier 25.
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On-Call Compensation Resources
In a new short video, Danielle Butto, DPM, shares national data on on-call compensation for podiatric physicians and lessons from her own experience successfully advocating for compensation. She discusses the importance of collecting hospital-specific data, demonstrating the value DPMs bring to their hospitals, working together with colleagues, and approaching negotiations strategically.
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APM Incentive Payments and MIPS Final Scores
CMS recently shared two updates related to Quality Payment Program participation.
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Modifier 25 Payment Cuts
CMS recently published the proposed rule for the Calendar Year (CY) 2027 MPFS, which includes an arbitrary 50 percent payment reduction for services reported on the same day with Modifier 25. APMA strongly opposes this policy, which would unfairly penalize physicians for providing necessary, distinct care during a single patient visit and could create new barriers to efficient, timely care.
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Payment Reform
As part of APMA’s ongoing collaboration with both the GOP Doctors Caucus and Democratic Doctors Caucus on Medicare physician payment reform, APMA recently submitted comments in response to the caucuses’ request for information on HR 9693, the Patients First Act.
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Opposing Modifier 25 Cuts
APMA and other medical specialty societies have formed the Same Day Care Coalition, to oppose cuts to Modifier 25 cuts. In addition, APMA is meeting with congressional podiatry champions and reaching out to Trump Administration officials.
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Medicare Adds Four DMEPOS Items
Effective October 28, Medicare will add four items to the Master List that may be relevant to podiatric physicians. Inclusion on the Master List does not mean an item requires prior authorization. Rather, items on the Master List have been identified by Medicare as potentially susceptible to fraud or unnecessary utilization and may be subject to additional conditions of payment.
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Topical Oxygen LCD
Last week, the DME MACs released a proposed LCD for treating non-healing diabetic foot ulcers with topical oxygen. The proposed LCD outlines coverage criteria required to initiate therapy and another set of criteria required to continue therapy beyond one month. This proposed LCD is now in a comment period, and APMA will be submitting comments on behalf of its members.
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In Memoriam: Arthur E. Helfand, DPM
It is with deep sadness that APMA announces the passing of Past President Arthur E. Helfand, DPM. Dr. Helfand was integrally involved in the work of the American Public Health Association Foot and Ankle Health section and a devoted advocate for public health and aging Americans. APMA extends its deepest sympathy to Dr. Helfand’s family.
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APMA Endorses Patients First Act
APMA proudly endorses the bipartisan Patients First Act (HR 9693), introduced by Representatives John Joyce, MD (R-PA); Kim Schrier, MD (D-WA); and Greg Murphy, MD (R-NC). The legislation represents an important step toward modernizing the Medicare physician payment system and strengthening access to physician-led care.
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