Who we serve · Podiatry

Podiatry practices. Every routine-care claim carries its own proof.

HRI Med carries Health Revenue Intelligence's billing and denial work over to independent podiatry practices, and adds payer enrollment. We enroll the practice and every podiatrist with each payer, set up the separate supplier enrollment that diabetic shoes require, and build each foot-care claim with the findings Medicare asks to see.

Request a review Where payers push back

iWhere payers push back

Routine care, class findings and the shoe rule.

Medicare excludes routine foot care, such as nail debridement and callus care, unless a systemic condition like diabetes or vascular disease makes it a professional's job. For several of those conditions, a medical or osteopathic physician must also be actively treating the patient and document it.^A

The claim has to show it. Novitas, one of the Medicare contractors, wants a Q7, Q8 or Q9 modifier naming the class findings on each such claim and, where the active-care rule applies, the date the patient last saw the treating physician.^B In CMS's own review of podiatry claims, insufficient documentation caused 76.4% of improper payments.^C

Diabetic shoes and inserts are a second enrollment. Medicare pays for them only through a supplier holding a DMEPOS supplier number, issued one per location, and nothing furnished before that number is issued is paid.^D The podiatrist may order and dispense them. The certifying statement must come from the medical or osteopathic physician managing the diabetes, after an in-person visit, and never from a podiatrist.^E

UnitedHealthcare's commercial plans require prior authorization for bunion, hallux rigidus and hammertoe correction, and in most states they review the site of service in the same request.^F Medicare pays many procedures at one rate in the office and another in a hospital outpatient department or surgery center, and the place-of-service code decides which.^G In nursing homes, a skilled nursing resident in a Part A stay is paid at the facility rate, and a nursing facility visit is not.^G^H

iiWhat we run

Both enrollments, and claims built to the contractor's rules.

Enrollment: The practice and every podiatrist, with Medicare, Medicaid and each commercial plan on your list, plus a DMEPOS supplier enrollment for each office that dispenses shoes or braces. Each followed to an effective date.
Claims: Routine-care claims built with the modifier and physician details your contractor asks for. Shoe claims held until the certifying statement is in.
Authorizations: Surgery requested before it is scheduled, with the site of service the plan will accept.
Denials: Each one traced to what the claim lacked, whether a finding, a modifier or the certifying statement, and appealed where the practice is owed.
The Friday board: Every open application, the supplier enrollment among them, and once billing runs, each foot-care claim paid, denied or paid short.

Fees for a podiatry practice. The full card is on the pricing page.
Piece of work	Fee
The practice, with each payer	$350
Each podiatrist, with each payer	$250
A podiatrist's CAQH ProView profile (CAQH now operates as DataSpring), built or repaired	$150
One written answer on a new service, such as diabetic shoes	$2,500
Billing and revenue cycle	By agreement

Total your own enrollment with the calculator.

iiiQuestions

Common questions from podiatry practices.

Why are our nail care claims denied when the patient has diabetes?

The diagnosis alone does not carry the claim. It needs the class findings and, under the active-care rule, the physician treating the condition. We check both before any routine-care claim goes out.

Can our podiatrist bill Medicare for diabetic shoes?

Yes, once the office is enrolled as a DMEPOS supplier. We collect the certifying statement from the physician managing the diabetes before the claim is built.

We are opening a second office. What has to be filed?

Each payer needs the new address. If the office will dispense shoes or braces, it needs its own supplier enrollment too.

Sources

CMS, Medicare Benefit Policy Manual, chapter 15, section 290. Read 2026.
Novitas, Billing and Coding article A52996, Routine Foot Care. Read 2026.
CMS, Medicare Provider Compliance Tips, Podiatry Care. Read 2026.
42 CFR 424.57(b), DMEPOS supplier standards. Read 2026.
DME MAC policy article A52501, Therapeutic Shoes for Persons with Diabetes. Read 2026.
UnitedHealthcare, commercial prior authorization requirements, foot surgery, and its Surgery of the Foot medical policy. Read 2026.
CMS, Medicare Claims Processing Manual, chapter 12, section 20.4.2, where the place of service sets the rate, nursing facilities included. Read 2026.
CMS, Place of Service Code Set. Read 2026.

Send us the foot-care claims that keep coming back.

Name the services, the payers and the denial reasons. We tell you what the claims are missing. No patient information is needed.

Say whether the practice sees patients in nursing facilities as well as the office.

Request a review