The Podiatry Reimbursement Landscape
Five revenue streams. Five rule sets. One margin at stake.
Podiatry is not one line of business — it is an E/M practice, a surgical practice, a wound-care program, and a DME supplier at once, and the economics turn on how well each stream is coded, documented, and contracted.
Evaluation and management and routine foot care anchor the schedule, but routine care sits behind Medicare's routine-foot-care exclusion — payable only when an at-risk systemic condition is documented and the correct Q modifiers and class findings are attached. In-office procedures and ambulatory surgery — bunionectomy, hammertoe correction, and the like — carry meaningful value but are exposed to site-of-service differentials and prior authorization.
Diabetic-foot-ulcer wound care and DME compound the complexity: custom orthotics, therapeutic shoes under the Therapeutic Shoe Bill, offloading devices, and total-contact casting all demand exacting documentation to be covered and to survive audit. Meanwhile, imaging and non-invasive vascular testing add ancillary revenue, and payers, orthopedic groups, and PE-backed platforms are consolidating podiatry alongside vascular and wound care. The same practice can be worth dramatically different amounts depending on how these streams are managed — and that is precisely where Fulcrum works.
Illustrative composition. Replace with your confirmed figures before launch; reflects current CMS/MedPAC methodology and public payer data, 2024–2026.
