CommercialCoverageMedium impact
25-273m Reimbursement Update for Routine Foot Care
Health Net·Podiatry, Family Medicine, Internal Medicine +1 more·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Effective January 1, 2025, Health Net Ambetter HMO and PPO plans now cover routine foot care services following CMS guidelines. The policy specifies covered CPT codes for nail trimming, debridement, and callus removal, along with required modifiers (Q7, Q8, Q9) for proper billing and cost-sharing calculations.
Action Required
Immediately: Billing team must update system to recognize routine foot care CPT codes (11719, 11720, 11721, G0127, 11055, 11056, 11057, G0427, S0390) as covered services for Ambetter HMO and PPO plans. Configure billing software to apply appropriate modifiers Q7, Q8, or Q9 based on patient findings. Update encounter forms to remind all providers that any certified physician or NPP can bill these services, not just podiatrists.