Ambetter Routine Foot Care Update

Date: 01/17/25

Routine Foot Care

Effective 1/1/2025 Ambetter from Arizona Complete Health 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).

Routine foot care services are not restricted to podiatrists. Routine foot care services may be provided by any certified physician or non-physician specialty.

Based on CMS guidance for routine foot care, we are adding modifiers Q7, Q8 and Q9 to our system configuration to make sure benefit(s) apply accurate member cost share for routine foot care services.

The Surgical/Specialist/Doctor/Facility cost share (specific cost share amount depends on the billing provider) will be applied to non-routine foot care services.  

Prior authorization may be required. To confirm if a CPT/HCPCS code requires prior authorization, please use the  Ambetter from Arizona Complete Health (Marketplace) Pre-Auth Check Tool on our website www.arizonacompletehealth.com > For Providers > Pre-Auth Check.

If you have questions, please contact your AzCH Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us AzCHProviderEngagement@azcompletehealth.com.