Advocacy News

Collaborated to Improve FCSO, Novitas, and Other MACS to Surgical Treatment of Nails Policy

Following more than a year of APMA's advocacy efforts on your behalf, Novitas and First Coast Part B MACs have revised their Surgical Treatment of Nails LCAs to allow submission of medically necessary repeat nail avulsions (CPT® 11730) and medically necessary repeat nail excisions (CPT 11750) with a KX Modifier appended when the medical record specifies the indication for the repeat procedure, such as ingrown nail of the opposite border or new significant pathology on the same border recently treated. This revision eliminates the need to submit redetermination requests for medically necessary repeat procedures when submitting to these two Part B MACs. APMA is currently determining if these changes apply to the other five Part B MACs in the country. We will keep members informed.

Worked with CAC Representatives to Fix FCSO, Novitas Steroid Denial Issues

Based on inquiries from APMA and its Contractor Advisor Committee (CAC) representatives, Novitas and First Coast Service Operations (FCSO) have confirmed they have added the provider type (30) for podiatrist to their claims processing systems for J1010, and acknowledged that the denied claims were most likely processed before that correction. Podiatrists in Novitas and FCSO who have experienced inappropriate denials related to this code should resubmit those claims for processing. APMA is working to resolve this issue with other MACs and will provide updates as they are available.

Lobbied CMS and Received MIPS EUC Exception Related to Change Healthcare Cyberattack

Thanks to APMA and others' advocacy on your behalf, CMS is now allowing providers impacted by the Change Healthcare cyberattack to apply for a hardship exception from MIPS participation in 2024! APMA and others requested that CMS allow providers impacted by the Change Healthcare cyberattack to apply for a hardship exception from MIPS participation in 2024. This request has been granted! MIPS Extreme and Uncontrollable Circumstances (EUC) are events “outside of a provider’s control” that prevent the provider “from collecting MIPS data for an extended period of time.” The 2024 MIPS EUC application has been released and allows providers to request an exception from having to perform one or more MIPS performance categories, including all of them.