August 2026 Monthly AFCNA Webinar-AFCNA_NGS_2026_MA

AFCNA_NGS_2026_MA_Reimbursement

Pdf Summary

This document is an educational reference for <strong>2026 Medicare NGS reimbursement rates for Massachusetts NP podiatry and foot care services</strong> under MAC 14212, effective <strong>January 1, 2026</strong>. It uses CMS Final Rule <strong>CMS-1832-F</strong> and a <strong>non-QP conversion factor of 33.4009</strong>.

Key points:
- Massachusetts has <strong>two Medicare localities</strong>:
  - <strong>Metro Boston (Locality 01)</strong> with higher GPCI values
  - <strong>Rest of Massachusetts (Locality 99)</strong>
- Rates shown are for the <strong>office/non-facility setting</strong>. Facility rates are lower.
- <strong>Nurse practitioners billing under their own NPI receive 100% of the PFS rate</strong>.
- The patient generally pays <strong>20% coinsurance</strong>; the table also lists the 80% Medicare payment amount.

The document includes 2026 reimbursement amounts for many common services, including:
- <strong>E/M office visits</strong> (99202–99215)
- <strong>Home visits</strong> (99341–99350)
- <strong>Nail care</strong> procedures such as debridement, avulsion, and matrixectomy
- <strong>Anesthesia/lidocaine</strong> services, including <strong>64450</strong>
- <strong>Wound care</strong> codes like selective and non-selective debridement
- <strong>Skin/soft tissue</strong> procedures
- <strong>Orthotics/casting</strong>
- <strong>Diabetes foot exams</strong>
- <strong>Care management, telehealth, preventive counseling, and education</strong>

Important billing notes:
- <strong>J2001 lidocaine is contractor-priced</strong>, not RVU-based.
- <strong>Hospice-related billing</strong> requires correct <strong>GW/GV modifiers</strong> depending on whether the service is unrelated to the terminal condition or the NP is the attending.
- The guide explains how to determine locality, use the non-facility rate, and verify current yearly updates.

A major coding reminder concerns <strong>CPT 11750 (nail matrixectomy)</strong>:
- It has a <strong>10-day global period</strong>, not 90 days.
- Routine postoperative care is bundled.
- It should generally be billed <strong>once per digit</strong>, with proper toe modifiers (TA–T9).
- The document also gives modifier guidance for unrelated visits, staged procedures, and different toes.

Keywords

2026 Medicare

Massachusetts reimbursement

NP podiatry

foot care services

MAC 14212

CMS-1832-F

non-QP conversion factor

office non-facility

nail matrixectomy

billing modifiers