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I was just wondering if a specialist such as a podiatrist must indicate CPT/HCPCS codes that may be used prior to seeing an HMO patient (new or established) in the prior authorization provided to the patient's primary MD/DO. Because when referrals are sent to the office by the patient's primary care provider sometimes all we get is CPT code E/M 99205 and 99215 (for multiple visits). Neither of these CPT codes are rarely if ever used for any new or established patients in the office and hence cannot be billed. New patients that are scheduled usually try to indicate their complaint when making an appointment, but even with that said the prior authorization CPT codes may only include E/M codes 99202-04 and 99212-14 based on the complaint and if foot care is required then CPT codes 11719, G0127, 11720-21, and/or 11055-57 may be included as well. But again, it is hard to determine exactly which CPT codes need authorization especially on the new patient. This is not as difficult with the established patient since most prior authorizations are good for up to a year. I have heard that certain carriers will allow back dating authorizations for 6 months especially when there are cases where certain codes were not authorized. I have also heard that all the specialist has to state on the prior authorization is "diagnose and treat" which will cover all required CPT/HCPCS codes for a particular date of service whether the patient is new or established to cover services. Is that correct?

I heard there is a new HCPCS code L1952. What is this new code and how is it different from the existing code(s) maybe L1951? I also don't have a fee schedule for this, how do I find this?

Today I heard that the CTP policy which was to become effective Monday April 13 has been proposed again. Is this true and if so, why did they wait until the last minute?

I recently read that one cannot ever bill for L3000 for diabetic patients. Does that include all L300X category devices. I don't see the logic here. Please explain and/or correct the other posting.

I work in a very large group practice located through a large geographic area in the State. I do not perform foot or ankle surgery. However, if I were to refer a patient within the practice to a foot/ankle surgeon who travels to my locale to perform the surgical consultation and the surgery and then, I choose to provide the post-operative care is referred back to me to manage and I able to bill for those post-op services? Or is that part of the global period? I understand that I would need to use the modifiers -54 or -55 to indicate on the CMS-1500 claim who's doing the post operative care and or surgery, correct? Can you allude to the possible medicolegal ramifications if a physician is only participating in the post-op care.

Recently Aetna Health Care has enforced a new national policy on foot orthotics. They are now conducting audits and enforcing the new policy retroactive to the effective date of the policy. How do I defend against this?

In yesterdays Medicare MLN Matters April 2025 , there was information regarding the DMEPOS fee schedule. There was a code listed there that was reimbursable, L4205 — Repair of orthotic device, labor component, per 15 minutes. Can you tell me what if anything I would need to do in order to bill for this code?

I performed an ankle scope and the patient and found an osteochondral defect. I did excise repair and drilled it. What code what I use to bill. Thank you

Can I be paid for both on the same date of service?