Tonia Silva CPC, CPMA, CPPM

12/06/2025

These changes are HUGE and have the potential to greatly affect patient care!

Beginning January 1, 2026, Medicare Part B will introduce three major policy changes that directly affect how podiatrists provide and bill for skin substitute applications.

To support members through these updates, APMA has developed a concise 20-minute explainer video outlining what’s changing and what practices should prepare for now.

APMA members: Stay informed, stay compliant, and get ahead of the transition.

➡️ Watch the full breakdown here: https://us02web.zoom.us/rec/component-page?eagerLoadZvaPages=&accessLevel=meeting&hasValidToken=false&clusterId=us02&action=play&filePlayId=&componentName=recording-register&meetingId=-mBEOHZ5uIzueFF5S8hJkFK-LKchjfvIIDyw66vb7Ju7JU0PncyYlGBEYrBs7-Sk.tyy24ni_SB3sMMlQ&originRequestUrl=https%3A%2F%2Fus02web.zoom.us%2Frec%2Fshare%2Fd0nKr_LPXVyYQVSH4hKTGvdBq1lMIoDm5te2NKv_VngZKxZW6p9Ef57Y8nJtuAwb.BOFiVQ3KyPk8uttm%3FstartTime%3D1763581440000

12/06/2025

Please take the survey. I have been facilitating the proper documentation for DM shoes for many years, even won an appeal at the judicial level!! I can sincerely say that the requirements are burdensome and this directly affects patient care!
https://www.facebook.com/100064730044224/posts/1289559203211736/?mibextid=CDWPTG

APMA is gathering critical information on the documentation challenges podiatrists face when prescribing therapeutic footwear for patients with diabetes under Medicare, and we need your input.

Your input is essential to APMA's advocacy efforts as we work to reduce unnecessary administrative burdens and improve patient access.

Please take a couple of minutes to complete this four-question survey and help strengthen our data on documentation challenges:
https://www.surveymonkey.com/r/XS6GGLB

12/02/2025

Wow, errors already?

CMS Issues “Thanksgiving Leftovers” in the form of Technical Corrections to the CY 2026 Medicare Physician Fee Schedule

Today, November 28, 2025, CMS quietly released a two-page correcting notice via the Federal Register, addressing several “typographical and technical errors” in the CY 2026 Physician Fee Schedule (PFS) final rule. While administrative on the surface, these updates directly impact reimbursement for skin substitute products—a major cost and utilization category in wound care.

Key Changes

• Verbiage in the final rule was corrected to describe skin substitutes as biological products (not “drug or biological products”).
• CMS corrected payment-rate language across several PFS tables.
• The final CY 2026 Medicare payment rate for skin substitutes is $127.14/cm²—not the originally printed $127.28/cm².
• Importantly, this aligns with the rate published in last week’s OPPS Final Rule, ensuring consistency across Part B and hospital outpatient billing.

Looking for more information on the PFS and OPPS, along with more timely updates on CTP regulations and policy? Visit the CTP News Desk for this story and more: https://tinyurl.com/24c638wz

12/02/2025

🤯"did not matter which kind of debridement a Vohra physician performed because Vohra allegedly programmed its electronic health record and billing software to ensure that Medicare was always billed for the higher-reimbursed surgical excisional procedure and to create false medical record documentation to support the scheme"

Vohra Wound Physicians and its owner have agreed to pay $45 million to resolve allegations that they violated the False Claims Act by knowingly causing the submission of claims to for medically unnecessary surgical procedures and wound care services. Read more: https://direc.to/fREt

11/15/2025

Great article, thank you Dr Lehrman for making this a bit easier to understand.

On October 31, 2025, CMS released its “CY 2026 Medicare Physician Fee Schedule Final Rule.”1 This Rule finalized a new payment model for skin substitute products applied to Medicare Part B beneficiaries during a covered application procedure in a non-facility setting and in the hospital outpatie...

11/14/2025

Stay tuned as more information becomes available on regulatory updates like the following, including this new info on the payment structure in the CMS physician fee schedule for skin substitutes.
https://tinyurl.com/595rsvec

11/14/2025

https://telehealth.org/blog/senate-passes-cr-extending-medicare-telehealth-flexibilities-through-january-2026/?fbclid=IwY2xjawOEEA5leHRuA2FlbQIxMQBzcnRjBmFwcF9pZAwzNTA2ODU1MzE3MjgAAR4ELaEcCxxbdQYzc6xKqf_1PWL4zbJKbYErSlQc8UhabLnqlwaT6s-hLC9pdg_aem_zfomDcZWcv9DzQU5oGn6Jg

The Senate approved a continuing resolution on November 10, 2025, that would extend key Medicare telehealth flexibilities through January 30, 2026.

11/01/2025

2026 Medicare Physician Payment Rule Finalized:
✅Increase in Medicare Physician Payment for 2026
✅Increase in Value for Both Great Toe Arthrodesis CPT Codes
✅New Skin Substitute Payment Policy Finalized
APMA will review the over 2,000-page rule and provide more information! Read more at www.apma.org/MPFSfinalrule.

10/28/2025

If you dispense DME get ready for some take backs on claims for patients that were in a SNF.

A new HHS-OIG audit found that improperly paid suppliers $22.7 million for durable medical equipment, prosthetics, orthotics, and supplies during inpatient stays from 2018–2024. Medicare policy requires these items be provided by the inpatient facility or through its arrangements—not billed separately by suppliers.

In addition, suppliers may have incorrectly collected up to $5.9 million in deductible and coinsurance amounts from enrollees.

We have recommended CMS direct Medicare contractors to recover improper payments from suppliers and ensure suppliers refund enrollees for deductibles and coinsurance. Additionally, CMS should refine its system edits to prevent future errors.

Read the full report here: https://direc.to/fQDj

10/20/2025

The WISeR Model Provider/Supplier Guide is now available. Still no template for the forms, nor a detailed data-element list, nor a portal as of today.

10/11/2025

Pneumatic compression coverage criteria

Medicare covers pneumatic compression devices (PCD) for home use when treating lymphedema or chronic venous insufficiency but only after a physician-supervised trial of conservative therapy has failed to improve the condition. This trial must include compression garments, limb elevation, and exercise for at least four weeks (lymphedema) or six months (venous ulcers) before coverage is approved. Check out our PCD website page for more information.
JA: https://bit.ly/42qEHe1
JD: https://bit.ly/3N9QyJ9