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Following more than a year of APMA's advocacy efforts on your behalf, Novitas and First Coast Part B MACs have revised their Surgical Treatment of Nails LCAs to allow submission of medically necessary repeat nail avulsions (CPT® 11730) and medically necessary repeat nail excisions (CPT 11750) with a KX Modifier appended when the medical record specifies the indication for the repeat procedure, such as ingrown nail of the opposite border or new significant pathology on the same border recently treated. This revision eliminates the need to submit redetermination requests for medically necessary repeat procedures when submitting to these two Part B MACs. APMA is currently determining if these changes apply to the other five Part B MACs in the country. We will keep members informed.
Based on inquiries from APMA and its Contractor Advisor Committee (CAC) representatives, Novitas and First Coast Service Operations (FCSO) have confirmed they have added the provider type (30) for podiatrist to their claims processing systems for J1010, and acknowledged that the denied claims were most likely processed before that correction. Podiatrists in Novitas and FCSO who have experienced inappropriate denials related to this code should resubmit those claims for processing. APMA is working to resolve this issue with other MACs and will provide updates as they are available.
Thanks to APMA and others' advocacy on your behalf, CMS is now allowing providers impacted by the Change Healthcare cyberattack to apply for a hardship exception from MIPS participation in 2024! APMA and others requested that CMS allow providers impacted by the Change Healthcare cyberattack to apply for a hardship exception from MIPS participation in 2024. This request has been granted! MIPS Extreme and Uncontrollable Circumstances (EUC) are events “outside of a provider’s control” that prevent the provider “from collecting MIPS data for an extended period of time.” The 2024 MIPS EUC application has been released and allows providers to request an exception from having to perform one or more MIPS performance categories, including all of them.
Following advocacy by APMA and others, effective January 1, 2024, ready-to-wear, gradient compression garments will be covered for the treatment of lymphedema in the absence of an open ulcer. Coverage for compression garments used for chronic venous insufficiency is unchanged. Details of this exciting change can be found on www.apma.org/coding.
After a years-long effort, the Alabama Podiatric Medical Association (ALPMA), with assistance from the APMA Center for Professional Advocacy (CPA), successfully modernized the Alabama scope-of-practice statute to include the ankle, effective August 1, 2023. 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 informed APMA that effective July 23, 2023, it has dropped its external review program regarding use of the -25 Modifier when submitted with CPT® 11719-11721, G0127, and 11055-11057. Aetna has also mentioned that 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. A critical component of these efforts were the APMA Health Policy Committee’s -25 and -59 Modifier workgroups. These workgroups, other APMA members, staff, and consultants all contributed to this latest victory.
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.
Following APMA advocacy, CMS rescinded the regulations regarding appropriate use criteria for advanced diagnostic imaging in the 2024 Physician Fee Schedule Final Rule. APMA has previously educated members about this program which would have required burdensome steps for those ordering MRI, CT scans, or nuclear studies for Medicare Part B outpatients. Over the last several years, APMA representation communicated both in live meetings and in written form with CMS on multiple occasions explaining the tremendous burdens imposed by this program and asking that this program be rescinded.
Since 2022, APMA has been coordinating a coalition of almost 20 medical societies to address concerns related to changes to the CAC feedback process brought about by 21st Century Cures Act. The coalition’s goal is to help improve the process for developing LCDs and LCAs and contribute to more reasonable policies and better beneficiary care. APMA and the coalition have experienced several challenges with the Local Coverage (LC) process in recent years and have brought those concerns to CMS’ Coverage and Analysis Group (CAG) and the MACs. Specifically, APMA and the coalition raised the following issues:
APMA has met with CMS on a number of occasions and submitted to CMS and the MAC Workgroup its Principles of Sound Local Coverage Policies and consensus answers to questions raised by CMS and the workgroup.
APMA will continue to work with the CAC Engagement Coalition, the MACs, and CMS to address these concerns and work toward overall process improvements. Read the comments and Principles of Sound Local Coverage Policies at www.apma.org/CommentLetters.
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!