APMA News - September/October 2020 - 20

Health Policy Workgroups Convene to

RESOLVE PROBLEMATIC
PAYMENT POLICIES

A

t its annual committee meeting in June, the Health
Policy and Practice Committee (HPPC) formed two
workgroups, one charged to address problematic payment policies related to the -59 modifier and routine
foot care, and the other focused on the -25 modifier and reimbursement of "significant, separately identifiable evaluation and management (E/M) service by the same physician on
the same day of the procedure or other service." Members
have reported to APMA that they are experiencing issues in
these areas with Medicare Advantage plans, Medicaid managed care organizations, and commercial plans.
Led by longtime HPPC Member Ed Prikaszczikow, DPM,
the initial focus of the -59 Modifier Workgroup is to develop
educational materials and resources to help members when
Medicare Advantage plans, Medicaid managed care organizations, or commercial plans deny covered nail care (CPT®
11720/11721) when callus care (CPT 11055-11057) is provided on the same date. To help members resolve these issues, the workgroup is creating template letters, articles, infographics, and webinars.
This workgroup is also charged with developing a plan to
advocate for updates to the National Correct Coding Initiative (NCCI) Policy Manual for Medicare. In 2018, APMA secured a victory that resulted in NCCI updating its guidance to
address use of the -59 modifier when CPT 11055 and 11720
are performed together. This victory resulted in coverage of
nail debridement when callus paring or cutting is performed
20 APMA News September/October 2020

proximal to the DIPJ of the same toe that has a nail debrided.
APMA recently contacted CMS to request that those changes
be made consistent throughout the NCCI Policy Manual for
Medicare. The workgroup will also advocate for coverage of
nail debridement without any restrictions related to callus
paring or cutting.
The -25 Modifier Workgroup is led by HPPC Chair Emeritus Mark Block, DPM. APMA has been fighting the trend of
reimbursement reduction related to billing with the -25 modifier for several years, and previously partnered with AMA
and its specialty societies to address these issues. While
APMA and its coalition partners achieved several successful
outcomes with Blues plans in the past, members have reported they are experiencing resurgence of the issue and new payers adopting similar policies. One of the main purposes of
this workgroup is to address and advocate against the existing
reimbursement reductions that Medicare Advantage, Medicaid managed care organizations, and commercial payers have
put in place, and to prevent future reductions. This workgroup is also developing educational materials and resources
for members.
The workgroups are creating an advocacy plan for outreach
to national payers as well as toolkits and other resources to
help CAC and PIAC reps and state components advocate for
changes to these payment policies in their state. For more
information, contact APMA's Health Policy and Practice department at healthpolicy.hpp@apma.org. n


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APMA News - September/October 2020

Table of Contents for the Digital Edition of APMA News - September/October 2020

Contents
APMA News - September/October 2020 - Cover1
APMA News - September/October 2020 - Cover2
APMA News - September/October 2020 - 3
APMA News - September/October 2020 - 4
APMA News - September/October 2020 - 5
APMA News - September/October 2020 - 6
APMA News - September/October 2020 - 7
APMA News - September/October 2020 - Contents
APMA News - September/October 2020 - 9
APMA News - September/October 2020 - 10
APMA News - September/October 2020 - 11
APMA News - September/October 2020 - 12
APMA News - September/October 2020 - 13
APMA News - September/October 2020 - 14
APMA News - September/October 2020 - 15
APMA News - September/October 2020 - 16
APMA News - September/October 2020 - 17
APMA News - September/October 2020 - 18
APMA News - September/October 2020 - 19
APMA News - September/October 2020 - 20
APMA News - September/October 2020 - 21
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APMA News - September/October 2020 - 24
APMA News - September/October 2020 - 25
APMA News - September/October 2020 - 26
APMA News - September/October 2020 - 27
APMA News - September/October 2020 - 28
APMA News - September/October 2020 - 29
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APMA News - September/October 2020 - 37
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APMA News - September/October 2020 - 40
APMA News - September/October 2020 - 41
APMA News - September/October 2020 - 42
APMA News - September/October 2020 - 43
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APMA News - September/October 2020 - 45
APMA News - September/October 2020 - 46
APMA News - September/October 2020 - 47
APMA News - September/October 2020 - 48
APMA News - September/October 2020 - 49
APMA News - September/October 2020 - 50
APMA News - September/October 2020 - 51
APMA News - September/October 2020 - 52
APMA News - September/October 2020 - 53
APMA News - September/October 2020 - 54
APMA News - September/October 2020 - Cover3
APMA News - September/October 2020 - Cover4
APMA News - September/October 2020 - A1
APMA News - September/October 2020 - A2
APMA News - September/October 2020 - A3
APMA News - September/October 2020 - A4
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