10/22/2024    Lawrence Rubin, DPM

APMA Should Promote Annual Comprehensive Diabetes Prevention Foot Examination for At-risk Patients (Ron Freireich, DPM)

In a recent post, Dr. Freireich said, "If APMA
promotes an Annual Comprehensive Diabetes
Prevention Foot Examination, I hope they also
promote that the exam is not covered by insurance,
unless things have changed since this issue was
also brought up."

Actually, there has been some progress in gaining
covered podiatric Medicare diabetes amputation
prevention examination coverage. Although we have
not yet succeeded in gaining coverage for a
comprehensive diabetic foot examination (CDFE) to
screen for many potentially hazardous lower
extremity problems, podiatrists can now be well
reimbursed when providing new preventive care
management services and billing the new E/M codes
for Principal Care Management (PCM).

Along with the Medicare adoption of value-based
care guidelines, CMS launched its Medicare Chronic
Care Management program (CCM) program. CCM is a
remote patient care chronic disease management
program mostly for primary care MD/DO/NP providers
treating patients who have two or more qualifying
serious chronic diseases. In addition, there now
is the Medicare Principal Care Management (PCM)
program for specialty providers, such as
podiatrists, that only requires the patient to
have one qualifying serious condition.

CMS Medicare communications have confirmed that
podiatrists can be reimbursed for billed new E/M
codes for medically necessary preventive PCM care
examinations when patients have qualifying,
serious chronic diseases such as diabetic
peripheral neuropathy and/or peripheral artery
disease. Among other documented billing
requirements, PCM compliance guidelines require a
written care management plan that is documented
and also given to the patient, and the patient
must sign a written agreement to receive the
proposed managed care. Here is more information:
https://www.medicare.gov/coverage/principal-care-
management-services

Lawrence Rubin, DPM, Las Vegas, NV

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