March 11, 2024

APMA has been collaborating with Contractor Advisory Committee (CAC) representatives regarding the recent amendment to the National Government Services (NGS) routine footcare LCA, effective December 1, 2023. According to the updated LCA, a registered nurse (RN) with foot care certification, such as Certified Foot Care Nurse (CFCN®) or Certified Foot Care Specialist (CFCS), or equivalent credentials obtained through independent training supervised by professionals, is now authorized to provide covered foot care services under specific conditions:

• The services must be performed under the direct supervision of a physician or another qualified practitioner
• All requirements specified in the “incident to” provision of the CMS Medicare Benefit Policy Manual must be satisfied
• Proof of accredited Foot Care Nurse certification must be available for NGS upon request
• All other coverage provisions outlined in the Billing and Coding Article must be met.

This update allows, for example, an appropriately credentialed RN to perform at-risk foot care under the supervision of a nurse practitioner, potentially leading to reimbursement. APMA is concerned that this change may negatively impact podiatrists and may have more extensive future repercussions nationally. APMA has conducted two meetings to date with state leaders and other stakeholders from the NGS states, including most recently on March 7, and has set up a meeting with NGS to address our concerns. APMA also plans to address this issue at the upcoming House of Delegates Town Hall.

The APMA Health Policy and Practice Committee leadership, with input from the APMA Board of Trustees and APMA staff, has determined that due to the potential negative consequences on podiatric physicians in the NGS states and elsewhere nationally, APMA will contest policies that allow RNs to provide nail care under the supervision of physicians or other practitioners to protect podiatrists and the safety of their patients. Follow the APMA Weekly Focus for updates. If you have questions or concerns, contact the APMA Health Policy and Practice department at healthpolicy.hpp@apma.org.

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