Everything a Podiatry Practice Needs

Podiatrists are licensed by each state, and each state sets its own application, training and continuing education requirements. National exam results are part of most applications. In Pennsylvania, for example, the National Board of Podiatric Medical Examiners and its testing vendor decide whether a candidate may sit for Part III of the American Podiatric Medical Licensing Examination, and the results are forwarded to the state board.

Each new state means a fresh application with your school and residency verifications, exam results and verifications of every license you hold. We prepare each one, track it with the board until the license is issued, and keep every renewal and continuing education requirement on schedule afterward.

Podiatrists who prescribe controlled substances, for example after surgery, need a DEA registration. DEA registers a practitioner only when the state where they practice authorizes them to dispense controlled substances, and a separate registration is required for each principal place of business or professional practice, so a practitioner with locations in more than one state needs a registration in each. Some states also require their own controlled substance registration before DEA will register you.

DEA does not treat podiatrists as mid-level practitioners; its definition of a mid-level practitioner expressly excludes physicians, dentists, veterinarians and podiatrists. Your schedules still follow what your state allows.

Medicare treats a doctor of podiatric medicine as a physician for the services state law allows, and podiatrists are among the physicians who may opt out of Medicare if they choose to run a private-contract practice. Most podiatry practices stay in, though, because so many of their patients are on Medicare. We enroll you and your group through PECOS, then credential you with Medicare Advantage, Medicaid and commercial plans, with your CAQH ProView profile built and attested along the way.

Surgery and wound care need facility privileges as well. Hospitals and ambulatory surgery centers each have their own application, references, case logs and committee schedule, and every one has a reappointment cycle. We prepare each application and every reappointment packet before it is due.

Medicare excludes routine foot care: cutting or removing corns and calluses, trimming, cutting, clipping or debriding nails, and other hygienic and preventive maintenance. It also excludes treatment of flat foot and treatment aimed only at correcting a subluxated structure in the foot, while treatment of the ankle joint is covered. The exclusion depends on the service, not on who performs it, and it applies whether a podiatrist, an MD or a DO provides the care.

There are exceptions. Routine-type care is covered when it is a necessary and integral part of a covered service, such as treating an ulcer, wound or infection. Wart treatment is covered as it would be anywhere else on the body. Mycotic nails can be covered without a systemic condition when the record shows clinical evidence of mycosis and, for an ambulatory patient, marked limitation of ambulation, pain or secondary infection, or, for a nonambulatory patient, pain or secondary infection.

Routine care can also be covered when a systemic condition such as diabetes, peripheral vascular disease or certain peripheral neuropathies makes it a hazard for a nonprofessional to provide. For several of those conditions, the patient must be under the active care of an MD or DO who documents the condition; the contractor may treat that as met if the patient saw the MD or DO for the condition within the prior six months. The claim must show that physician's name, and where active care is required, the approximate date the patient was last seen.

The Medicare Benefit Policy Manual lets contractors presume routine foot care is covered for a patient with a qualifying systemic condition when the podiatrist documents findings that show severe peripheral involvement. The presumption applies with one Class A finding, two Class B findings, or one Class B and two Class C findings. Cases that fall short may still be covered after review.

The Q7, Q8 and Q9 modifiers that report those findings come from each Medicare contractor's billing article, and the articles differ. WPS's article A56232 requires one of them on every routine foot care claim based on a systemic condition. Noridian's article A57954 requires them for conditions with vascular impairment but not for neuropathy without vascular impairment. We follow your contractor's article, match the findings in the note to the modifier on every claim, and add the MD or DO details your contractor asks for, such as the date last seen.

Medicare covers depth or custom-molded shoes and inserts for patients with diabetes as a separate Part B benefit. The need must be certified by an MD or DO who manages the patient's diabetes under a comprehensive plan of care and documents at least one qualifying condition, such as peripheral neuropathy with evidence of callus formation, a history of pre-ulcerative calluses or ulceration, foot deformity, prior amputation or poor circulation. After that certification, a podiatrist may prescribe the footwear, and a podiatrist may fit and furnish it.

Coverage is limited each calendar year to either one pair of custom-molded shoes with two additional pairs of inserts, or one pair of depth shoes with three pairs of inserts. Claims go to the Durable Medical Equipment Medicare Administrative Contractor, not your Part B contractor, and to be paid you must be enrolled as a DMEPOS supplier on form CMS-855S, which lists physicians as a supplier type. A separate application is required for each physical location where you furnish the items, and every supplier must meet and maintain Medicare's supplier standards.

Patients look for a podiatrist when something hurts, and most search locally. We build and run your website, local search and AI search visibility, Google and Microsoft ads, and review requests, with pages for the conditions and procedures you want more of, from heel pain and ingrown nails to wound care and foot and ankle surgery. Because the same team runs your billing, the services you promote match what your payers cover and what you offer as self-pay.

Documentation is where podiatry claims fail. CMS reports that insufficient documentation accounted for 76.4% of improper payments to podiatric providers in its 2024 reporting period, ahead of incorrect coding. Claims must be supported by the patient's record, and anything you submit, including form letters, can be checked against it. We review notes against claims before they go out, especially for nail care, class findings and diabetic shoes.

Your practice also handles protected health information in the office, in facilities and through imaging and wound photos. We run your HIPAA security risk assessment, write your policies, train your staff and collect business associate agreements from every vendor that handles patient data.