09/25/2026

Coding & Compliance: New Plantar Fasciitis Codes Taking Effect October 1 & Anthem Orthotics Coverage and Recoupments

Stay in the know with these updates

New Plantar Fasciitis Codes

The ICD-10 CM clinical modification code set updates each year on October 1. This year, there are notable changes for podiatric physicians.  M72.2 will no longer be an ICD code and cannot be used for services performed on or after October 1, 2026.

Watch APMA's short webinar on the changes here.

Anthem Orthotics Coverage and Recoupments

APMA is investigating reports from members in several states, including Ohio, that Anthem is seeking repayment of previously paid commercial claims for foot orthotics, including claims dating back to 2024.

Antem’s Orthopedic Footwear (CG-DME-20) policy generally limits coverage of orthopedic footwear, including inserts and other shoe modifications, for non-diabetic patients to situations where the item is part of a medically necessary leg brace and is necessary for the brace to function properly. While the policy has been in place for some time, members have raised concerns about recent retrospective recoupments, including situations where practices report that Anthem previously indicated the service was covered or that prior authorization was not required.

We are working to better understand what is driving these recoupments and is gathering information from affected practices. They are also reviewing the issues raised by prior authorization, benefit verification, payer coverage policies, and state laws governing retrospective recoupments. 

If you have received an Anthem recoupment request related to foot orthotics, please email Luci.

Helpful information includes the HCPCS code billed, type of Anthem plan, the stated reason for the recoupment, and any documentation received from Anthem before the item was dispensed. Please redact all patient-identifying information.

APMA is also developing additional guidance for members; OHFAMA will share more information as it becomes available.

WISeR Exemption Program

CMS recently released an updated WISeR Participant Guide that includes new information about an “Exemption Program,” which functions as a gold carding program for providers who consistently meet Medicare requirements.

Under the new policy:

• Providers must submit at least 10 prior authorization requests during the assessment period to achieve exemption.
• Providers must meet the participant's required prior authorization affirmation rate threshold during the assessment period.
• Exemptions are granted at the individual NPI level (not the practice level) and will be awarded quarterly.
• Once granted, exemption status lasts at least one year, subject to periodic reevaluation.

Though APMA opposes the WISeR program and similar prior authorization models, this is a positive development because APMA has long advocated for a gold carding approach to reduce administrative burden for providers with a strong track record of compliance.

Additional changes to the Participant Guide are summarized here.

MIPS Value Pathways (MVPs)

MVPs are one way (an alternative to traditional MIPS and APM Performance Pathway (APP)) that you can meet your MIPS reporting requirements. Each MVP includes a subset of measures and activities related to a given specialty or medical condition.

If you're planning to report a MVP this year, there's one easy step that can derail your MIPS reporting if it's overlooked: CMS requires a separate MVP registration. Many clinicians assume that participating with a qualified registry is enough, but without completing MVP registration through the Quality Payment Program (QPP) portal, you cannot report the MVP.

Proof point: CMS requires clinicians who choose to report an MVP to register through the QPP portal by 8:00 p.m. ET on November 30, 2026.

Registering is straightforward:

· Log in to your QPP account using your HARP credentials.

· Select Register or Edit an MVP Registration.

· Choose the MVP you wish to participate in and your reporting option (individual, group, subgroup, or APM Entity).

· Submit your registration and confirm that your status is marked Complete.

If you report through Registry Clearinghouse, remember that registry enrollment does not automatically complete your CMS MVP registration. Both steps are required.

Next step: If you have not yet registered, log in to the QPP portal and complete your 2026 MVP registration before the November 30, 2026, 8:00 p.m. ET deadline. If you have questions, contact the Registry Clearinghouse team for assistance before the registration window closes. Registry Clearinghouse is a member benefit partner with OHFAMA – Ohio Foot and Ankle Medical Association | Registry Clearinghouse For questions about MVP’s please contact Registry Clearinghouse directly - info@registryclearinghouse.com.