Podiatry Billing Services in New York
New York's podiatry practices face unique billing challenges shaped by Empire BlueCross BlueShield's commercial rules, NY Medicaid Managed Care requirements, and Novitas Solutions Medicare policies. Our AAPC-certified coders specialize in both NY payer rules and podiatry coding complexity.
Why New York Podiatry Practices Need Specialized Billing
New York's healthcare market includes 90,000+ physicians, and podiatry practices here face a payer market dominated by Empire BlueCross BlueShield on the commercial side and NY Medicaid Managed Care on the public payer side. Medicare claims are processed through Novitas Solutions, which applies its own Local Coverage Determinations that directly affect podiatry procedure coverage and medical necessity requirements. Generic billing teams without NY specific knowledge leave revenue on the table.
Podiatry billing itself is complex. Podiatry billing is uniquely complex because Medicare excludes routine foot care by default. Coverage requires documented systemic conditions (diabetes, peripheral vascular disease, peripheral neuropathy) that create a class finding making routine care medically necessary. Diabetic foot care certification (LOPS testing), nail debridement codes 11720-11721, orthotics L-codes, and the Medicare Therapeutic Shoe Program (A5500-A5513) each have their own coverage criteria. When you combine this coding complexity with New York's specific payer rules, authorization requirements, and 6 NY Medicaid Managed Care managed care plans that each have their own billing rules, you need a team that understands both dimensions. Go Medical Billing provides that expertise at 2.49% of collections, serving podiatry practices from New York City to Albany and across New York.
Top CPT Codes for Podiatry in New York
Our NY coders handle these podiatry codes daily, applying Novitas Solutions Medicare rules and Empire BlueCross BlueShield commercial policies to each claim.
New York Payer Challenges for Podiatry
Every NY payer has specific rules for podiatry claims. Here's how we navigate them.
Empire BlueCross BlueShield Podiatry Claims
Empire BlueCross BlueShield processes the largest share of New York commercial podiatry claims. We know their NY specific fee schedules, prior authorization requirements for podiatry procedures, and their appeal timelines when claims are denied. Medicare does not cover routine foot care (nail trimming, callus removal) unless a qualifying systemic condition and class finding are documented.
NY Medicaid Managed Care Podiatry Billing
NY Medicaid Managed Care routes podiatry patients through 6 managed care plans: Fidelis Care, Healthfirst, MetroPlus, and 3 more. Each MCO has its own podiatry authorization and billing rules that we manage.
Medicare (Novitas Solutions) Podiatry Coverage
Novitas Solutions processes Medicare podiatry claims in New York with its own Local Coverage Determinations. We navigate Novitas Solutions's policies around diabetic foot care certification to prevent medical necessity denials.
Denial Prevention for New York Podiatry
Common podiatry denials in New York include medicare does not cover routine foot care (nail trimming, callus removal) unless a qualifying systemic condition and class finding are documented and medicare requires an annual lops (loss of protective sensation) certification and a prescribing physician's statement for diabetic foot care coverage. Our team catches these issues before submission and appeals aggressively with NY payer-specific documentation when denials occur.
Get Expert Podiatry Billing in New York
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What We Handle for New York Podiatry Practices
New York Podiatry Billing Cost Comparison
Hiring an in-house biller with podiatry expertise in New York costs $45K-$62K annually in salary alone. Add benefits, software, clearinghouse fees, and office space, and the true cost is even higher. At 2.49% of collections, Go Medical Billing provides an entire team of AAPC-certified podiatry coders and NY payer specialists for a fraction of that cost.
$45K-$62K
In-House Biller Salary
+ benefits, software, space
2.49%
Go Medical Billing Rate
Full team, all services included
60-80%
Typical Cost Reduction
With better results
Related Pages
Explore our New York and podiatry billing resources.
Frequently Asked Questions
Fix Your New York Podiatry Billing
Call 888-701-6090 for a free billing assessment specific to your NY podiatry practice. We'll show you where revenue is leaking and how to fix it.