Therapeutic Shoe Claims and Poor Reimbursement
Several DPMs have been posting questions on what to do about $6 profit margins on therapeutic shoe claims by several Medicare “Disadvantage” plans. The answer sadly for your patients is to write a script and send the patient out. Your ROI is far less than the $6 many shoe provider’s quote for Part C patient. The time your practice needs to obtain pre-determination of benefits/prior authorization and other peripheral paperwork required to obtain the shoes, etc. leaves most practices at a loss when it comes to providing this service. Hence, in many areas of the country there are either only a few or no providers willing to continue to participate in this program. And that is for all insurance programs.
This issue has become a lightning rod even for traditional fee for service Medicare. The DME MAC Medical Directors are all acutely aware of this issue and have asked me numerous times where the problem is. By now you already know that I have told them to look in the mirror.
—Paul Kesselman, DPM (for Park DPM Consulting, LLC)
To read this entire article, click the button below. To submit a response or question, email [email protected].
Re: Looking for Answers: L3000 Denials
So there is no modifier other than to appeal the Blue Cross glitch, leaving us waiting for them to fix it, or for a new modifier? My Blue Cross rep and claims say we are billing wrong due to those denial codes and won’t tell us what is causing it. They would NOT let me talk to a supervisor. Many DPMs have stopped billing for orthotics not only from this new issue, but the fact it takes one and a half hours to talk to someone at Blue Cross about orthotic coverage (and still the people in customer service they use have no knowledge or proper training to decipher what they are reading to us) just to find out if they are covered only for diabetes or plantar fasciitis, or both. Availity has some insurance information of coverage, but not orthotics. So in today’s world of AI these so-called provider customer service call centers (most are overseas) are stuck in the 1980s.
We are seeing the same issues when two of any DME is dispensed for both feet, reimbursing for one only and all billed with one line item each. (This is Blue Cross Blue Shield of Texas PPO.) Does using one line with two units override those new edits?
Thank you to the docs who have responded!
—George Bakatsas, DPM
This original thread is available here. To ask a question or add your thoughts, email [email protected].
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Ulcer Debridement Coding
Question: Are we able to bill CPT15275, HCPCS Q4186, with CPT 97597 for ulcer debridement of the same area the skin graft was applied plus another ulcer same foot, different site? Should I bill an E+M as well?
Response from Codinghelpline.com:
Interesting question with a somewhat confusing answer. Let’s start by making some assumptions. This includes that both ulcers that add up to less than 25sq cm, and that they are on the same location (left foot) and the wound was debrided using a scalpel (sharp debridement). Let's also assume that you have properly documented the medical necessity for the use of CTP and the separate identifying site of the debridement and the physical characteristics of both sites.
The CTP claim is billed with the CPT 15275 (CTP to foot initial 25sq cm on a wound less than or equal to 100sq cm). The Q code representing the CTP applied is then billed. The number of units for the Q code will be represented by the sq cm of material actually applied to the wound. Wastage is not billed.
To read this entire article, click the button below. To ask a question or add your thoughts, email [email protected].
—Paul Kesselman, DPM
Additional coding and billing questions and responses can be found at www.Codinghelpline.com
Social Media Post of the Day
Please take a moment to read this fun and informative profile of Kristine Hoffman, DPM, chief of podiatry at Denver Health. "The feet are so underrated," Hoffman tells us. "They have all the complexity of hands with weight-bearing forces."
Learn how the field of #podiatry has grown over the past few decades, what some of the biggest challenges are, and how this dedicated surgeon keeps herself and her patients stepping forward through fly fishing and trail running—but at the same time. Yes, it's an actual sport. Hoffman brings passion and skill to every race and procedure.
Source: Read Pierce, CMO, Denver Health
How Confident Are You in Your Cybersecurity Setup?
Poll Results: What Portion of Your Work is Routine Foot Care?
Under 20 percent: 22 percent
20-40 percent: 19 percent
40-60 percent: 22 percent
60-80 percent: 23 percent
More than 80 percent: 11 percent
Total responses: 305
From the Magazine—October ‘26 Preview
The Rules of Practice Growth Have Changed
For decades, practice growth followed a familiar formula: Deliver excellent clinical care, build strong relationships with referring physicians, establish a trusted reputation in the community, and new patients would come.
For many podiatrists, that formula worked remarkably well. Today, something feels different…
This is not a cause for alarm. It is a call to adapt.
Webinar—Painful Diabetic Neuropathy: Beyond Opioids
During this free presentation on Thursday, November 19 at noon ET, Sallee Randolph, DPM, DAPM, FACPM, will provide clinicians with a practical approach to recognizing and evaluating painful diabetic peripheral neuropathy (DPN). Participants will learn to distinguish diabetic neuropathy from other potential causes of pain, avoid inappropriate escalation to opioid therapy, and identify patients who require specialty referral for further evaluation and management.
Source: PRESENT Podiatry
Managing a Practice Bankruptcy
Physician practices are filing for bankruptcy at a pace not seen in years. Medical Economics reported in July that practice bankruptcies are on pace for their highest level since 2019. The trend reflects a broader rise: total bankruptcy filings increased by 12.2% in the 12 months ending June 30, 2026, compared with the year before.
Many practice owners who reach that point find out too late what a filing involves, from an outside monitor overseeing patient care to years of patient records that still need a home after the doors close. Owners who plan for these issues early keep far more control over how things end.
Source: Physicians Practice
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PM Pulse Classified Ads
30-Year Podiatry Practice—Kansas City, Missouri
Priced below appraisal. Established hospital-campus practice with strong referrals and 25,000 patient records. Fully equipped with digital X-ray and EMR. Staff staying on. Open four days, with demand for five. Retiring physician will assist with transition. A rare turnkey opportunity. Confidential inquiries: [email protected]
For more information about submitting a classified ad, click the button below, or email [email protected].
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