By Medtransic | February 11, 2026 | 14 min read
Quick Summary: Podiatry billing is one of the most denial-prone specialties in medicine. Medicare's routine foot care exclusions, the Q modifier system, multi-procedure reductions, and the constant need to prove medical necessity create a billing environment where general medical billers consistently underperform.
Podiatry billing operates under a set of rules that don't exist in family medicine, orthopedics, or any other specialty. Many podiatric services are considered non-covered by Medicare unless the claim proves they're medically necessary.
Medicare's blanket exclusion of routine foot care, the Q modifier system (Q7, Q8, Q9), multi-procedure payment reductions, overlap between surgical and non-surgical billing, and stringent documentation requirements all make podiatry billing fundamentally different.
Medicare does not cover routine foot care including nail trimming (CPT 11719), debridement of nails (CPT 11720, 11721), and removal of corns and calluses (CPT 11055-11057) unless the patient has a documented systemic condition.
Q modifiers are required: Q7 (Class A - non-traumatic amputation), Q8 (Class B - absent pulses, trophic changes), Q9 (Class C - claudication, temperature changes, edema). Without the correct modifier, Medicare denies automatically.
Common pitfalls include incorrect bundling and unbundling of procedures, bilateral procedure errors with modifier 50 vs RT/LT, multi-procedure payment reductions applied incorrectly, wound care coding complexity for diabetic ulcers, and injection coding errors.
Underpayments are silent revenue killers. Industry estimates suggest underpayments cost the average podiatry practice about 10% of potential revenue — on a practice collecting $500,000 annually, that's $50,000 in lost revenue.
Comprehensive services include insurance verification, charge capture and coding review, claim submission, payment posting and EOB reconciliation, denial management and appeals, accounts receivable management, patient billing, reporting and analytics, and credentialing.
Ask about Q modifiers, underpayment tracking, how many podiatry practices they serve, podiatry-specific denial rate data, coding team credentials, and contract terms.
In-house billing costs $40K-$55K/year per biller. Outsourced costs 5%-10% of collections or $1,500-$4,000/month. Most solo and small-group practices outsource because podiatry-trained billers are scarce.
Clean claim rate above 95%, denial rate below 5%, average days in AR under 35, net collection ratio above 96%, and a 15% to 25% increase in collections within the first 90 days.
Medicare excludes routine foot care unless qualifying conditions are documented, requires Q modifiers, enforces multi-procedure reductions, and demands specific documentation for diabetic foot exams.
Not unless the patient has a documented systemic condition like diabetes with peripheral neuropathy or peripheral vascular disease. The claim must include the appropriate Q modifier.
Q7, Q8, Q9 modifiers indicate the severity of the patient's systemic condition. Q7 is Class A (amputation), Q8 is Class B (absent pulses, trophic changes), Q9 is Class C (claudication, edema).
Typically 5%-10% of monthly collections or $1,500-$4,000/month flat fee. Most practices see a 15%-25% increase in collections within 90 days.
Deep knowledge of Medicare routine foot care rules, Q modifier experience, underpayment tracking capability, podiatry-specific CPT and HCPCS code expertise, and transparent KPI reporting.
Missing Q modifiers, insufficient medical necessity documentation, incorrect bundling, bilateral modifier errors, missing prior authorizations, and not appealing underpayments.
Your practice deserves billing that understands podiatry. Contact Medtransic for a free billing assessment. Call 888-777-0860 or visit our contact page.