Ambetter Health billing guidelines for routine foot care

Date: 02/11/25

Ambetter Health reimburses for routine foot care in accordance with state mandates and Centers for Medicare and Medicaid Services (CMS) guidelines.

Routine Foot Care services are not restricted to podiatrists. These services may be used by any certified physician or non-physician (NPP) specialty. Based on CMS guide for routine foot care modifiers Q7, Q8 and Q9 are being added to further ensure Ambetter Health benefit(s) are applying routine foot care cost share for routine foot care services.

All other services will apply to Surgical/Specialist/Doctor/Facility cost share depending on provider billing. 

Effective January 1, 2025, routine foot care benefit(s) will be updated to align with the CMS guidance provided in Article - Billing and Coding: Routine Foot Care (A57957) (cms.gov)External Link.

Prior authorization may be required. Please reference the  Ambetter Health Provider Resources page.

Questions

Ambetter Health has a wealth of resources available to help answer your questions and address your concerns:

• Provider Services: Call 1-877-687-1169
• Provider Portal: Visit the Secure Provider Portal to check member eligibility, submit claims and more.
• Provider Engagement: Use the Find Your Account ManagerExternal Link tool to find the Provider Engagement Account Manager (PEAM) supporting your specialty and region.
• Provider News: Bookmark Provider News to keep up with the latest updates.
• Provider Newsflash: Subscribe to our e-newsletterExternal Link to get regular updates.
• Provider Resources: Visit Ambetter Health Provider Resources to find provider manuals, important forms, scheduling standards and other provider resources.