APMA and NYSPMA Meet with NGS to Address At-Risk Foot Care LCA Changes

Updated April 22, 2024

On Tuesday, April 16, APMA and NYSPMA met with National Government Services (NGS) to address their concerns about policy changes to allow reimbursement for Registered Nurses performing at-risk foot care under the supervision of a physician. APMA, NYSPMA, and other NGS Jurisdiction members have concerns that the changes included in the LCA will have a negative impact on the quality of care that beneficiaries receive.

The meeting was productive, with APMA indicating that podiatric physicians are uniquely trained to understand the anatomic structures involved with these services and have extensive training related to these services. Furthermore, other pathology is often encountered when performing this service, and other providers are not qualified to diagnose the pathology and establish appropriate management. Patients who qualify for this service are at extraordinary risk for lower extremity pathology, including non-healing wounds, infection, and amputation. Further, the certification required for nurses to provide care may likely lack sufficient rigor to prepare these nurses for providing the necessary care. Studies such as APMA’s Thomson Reuters study have indicated how care provided by podiatrists to diabetic patients, including at-risk foot care, can have a significant reduction on future amputations and hospitalizations. The study estimated that $10.5 billion in savings over three years can be realized if every at-risk patient with diabetes sees a podiatrist at least one time in a year preceding the onset of an ulceration.  NGS asked for APMA to provide these studies, as well as any positions that APMA has taken on this issue, in addition to the opinion of APMA’s membership on retaining foot care provided primarily by podiatric physicians.  APMA and NYSPMA plan to follow up with NGS after NGS has had a chance to review the materials provided after the meeting.

APMA has been collaborating with Contractor Advisory Committee (CAC) representatives regarding the recent amendment to the NGS at-risk foot care LCA, effective December 1, 2023. According to the updated LCA, a Registered Nurse with foot care certification, such as Certified Foot Care Nurse (CFCN®) or Certified Foot Care Specialist (CFCS), or equivalent credentials obtained through independent training supervised by professionals, is now authorized to provide covered foot care services under specific conditions:

• The services must be performed under the direct supervision of a physician or another qualified practitioner.
• All requirements specified in the “incident to” provision of the CMS Medicare Benefit Policy Manual must be satisfied.
• Proof of accredited Foot Care Nurse certification must be available for NGS upon request.
• All other coverage provisions outlined in the Billing and Coding Article must be met.

This allows, for example, an appropriately credentialed Registered Nurse (RN) to perform at-risk foot care under the supervision of a Nurse Practitioner, potentially leading to reimbursement. APMA is concerned that this change may negatively impact podiatrists and may have more extensive future repercussions nationally. APMA has conducted two meetings to date with state leaders and other stakeholders from the NGS states. APMA also addressed this issue at the recently completed House of Delegates Town Hall.

APMA Health Policy and Practice Committee leadership, with input from the APMA Board of Trustees and APMA staff, has determined that due to the potential negative consequences on podiatric physicians in the NGS states and elsewhere nationally, APMA will contest policies that allow RNs to provide nail care under the supervision of physicians or other practitioners to protect podiatrists and the safety of their patients. Follow the APMA Weekly Focus for updates. Contact the APMA Health Policy and Practice department at healthpolicy.hpp@apma.org with any questions or concerns.