Ultrasound Guidance Code Denial
Question: Why did Aetna deny my Ultrasound Guidance code when I injected the plantar fascia? I just found out that Aetna denies Ultrasound Guidance. How can they do this when it is medically necessary?
Response from Codinghelpline.com:
The answer to this question lies in the Aetna policy regarding Ultrasound Guidance. Please review the policy found here.
The basis for the denial is that Aetna considers ultrasound guidance for certain procedures to be experimental, investigational, or unproven. The policy includes numerous foot and ankle procedures, and many of the relevant CPT codes are specifically addressed.
My recommendation would be to appeal the denial. However, to have the strongest chance of success, the procedure note should clearly document why ultrasound guidance was medically necessary and why the injection could not have been safely or effectively performed without ultrasound guidance.
The appeal should also include supporting evidence-based medical literature demonstrating the clinical benefit and necessity of ultrasound guidance for the specific procedure performed. In addition, I would recommend including the applicable American College of Radiology (ACR) guidelines supporting the use of ultrasound guidance for this procedure.
The appeal should therefore focus on the patient-specific medical necessity of ultrasound guidance, supported by the procedure documentation, peer-reviewed literature, and applicable ACR guidelines.
—David J Freedman, DPM, CPC, CSFAC, CPMA Silver Spring, Maryland
Additional coding and billing questions and responses can be found at www.Codinghelpline.com. If you have a question you can’t find there, send it to [email protected].
Topical Oxygen Therapy Hearing and Podiatry
As noted in a previous posting, the DME MAC held a hearing on August 26, 2026, on a proposed LCD covering Topical Oxygen for the healing of DFU. Never can I recall being prouder to be a podiatrist. This hearing was filled with many podiatric physicians who dazzled the Carrier Medical directors and policy writers with amazing presentations. Each of them was knowledgeable and devoid of any negative emotion, discussing wound healing and topical oxygen for DFU in a concise and professional manner. Every one of them made me proud to be a member of this profession.
What most of you do not know is that the very next day, the DME MAC council of Regions B and C met. As a member of that council, I can report that the DME MAC was very impressed with podiatry’s mastering of this complex subject and will be carefully considering the materials presented and submitted by the speakers and those who submitted written comments!
Let this be a lesson that podiatry does have a voice in medical policy matters, and we should continue to provide a positive image of our profession by continuing to participate in these types of forums
Again, my congratulations to the many DPM colleagues who took the time to prepare presentations for these hearings and who have gained incredible expertise in the use of Topical Oxygen for DFU.
—Paul Kesselman, DPM
Preview: September ‘26 Podiatry Management
The Orthotic Management of Athletes
A functional foot orthosis is theoretically designed to influence the function of the foot. This differs from an accommodative orthotic, which would be used to accommodate rather than change the functional movement pattern of the foot, and by extension, the body.
Rethinking Surgeon-MSO Partnerships
Surgeons are holding MSO and health system partners to a different standard today than in the past, putting a new premium on transparency and flexibility.
Source: Becker’s ASC Review
What portion of your business does biomechanics comprise?
Worst Sources of Patient Misinformation
A new survey from The Physicians Foundation asked more than 1,000 U.S. physicians where the misinformation reaching their patients originates. Here are the eight biggest offenders.
Source: Richard Payerchin, Medical Economics
U of Michigan Podiatry Fellowship
Interested parties should complete and provide the information requested in the Podiatry Fellowship Training Program Application. Your application will not be processed or considered unless all information requested is received. Please refer to the application for how to submit once complete.
Application Deadline for 2027-28: 10.1.26 | Start Date: 7.7.27
Source: U of Michigan
Sports Podiatry Clinic Market Grows
Fueled by a surge In sports participation and rising demand for enhanced athletic performance, the sports podiatry clinic market size reached $1.54 billion in 2025 and is expected to grow to $2.3 billion in 2030.
Source: The Business Research Company
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Medical Staffing Getting Harder
Medical assistant hiring got harder for most medical group practices over the past year, and the difficulty is starting to look less like a temporary labor-market squeeze and more like a durable feature of how practices staff their clinical support roles.
Source: MGMA Stat
APMA Urges Podiatry Students to Speak Out on CMS and Modifier 25
You future DPMs are just a few years away from billing your first Medicare claim. The rules being written this fall are the ones you will practice under. To learn about the proposal or APMA's advocacy efforts, please refer to our Modifier 25 landing page. Help us urge CMS to withdraw this proposal.
Source: APMA Voter Voice
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PM Pulse Classified Ads
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