Non-AI technology is still leading innovation

Fluorescence wound imaging gets a permanent code, priced on the maker's numbers

Fluorescence imaging for wound bacteria is moving from temporary codes 0598T and 0599T to a permanent Category I code with the 2027 CPT set. The 2027 proposed physician fee schedule assigns it a value. As Scott Nelson reported, the CMS fact sheets skipped this; the rule text did not.

How it got its value is the story. The specialty society could not collect enough survey responses to meet the RUC threshold, so CMS priced the code from figures the manufacturer supplied: a work RVU of 0.80 and 26 minutes of physician time. Practice expense is crosswalked to ultrasonic wound assessment (CPT 97610) plus 10 minutes for cleaning the instrument pack. The equipment cost comes from MolecuLight's own invoices: $21,500 over a five-year life.

CMS is also watching for double payment. The temporary codes were billed alongside debridement 35.1% and 46.6% of the time, and the proposal asks whether some supply costs already sit inside debridement. A dollar payment cannot be calculated until the full practice-expense and malpractice values are published. Four companies sell this kind of imaging, and two are in litigation over an International Trade Commission complaint filed in January.

The skin substitute rate holds for 2027, and the clock keeps running

CMS proposes to keep a single flat rate for skin substitutes in 2027: $127.14 per square centimeter across all three sites of care, against $127.28 in 2026. The industry spent a year expecting separate rates by FDA category. CMS now says it lacks enough 2026 claims data to set them and has pushed that decision to 2028.

One change hides under the unchanged number. Pastes, powders and other non-sheet products have been priced at each Medicare contractor's discretion since January. The proposal folds them into the same national per-square-centimeter pricing, which ends any favorable local rate a product enjoys today.

Nelson's read is that 2027 is not a quiet year. It is the last year to build the clinical, coding and utilization record that decides where each product lands when differentiated rates arrive.

Remote monitoring may need your own staff, and telehealth has a runway

The 2027 proposal rewrites how remote patient monitoring and remote therapeutic monitoring get delivered. Both would need a separately billed initiating visit, and RTM would follow RPM's established-patient rule. The change with teeth: only staff employed by the billing practice could deliver the treatment-management time. Contracted staff would not count.

Nelson points out that a large share of remote monitoring runs through outsourced vendors. If this is finalized, that model stops being billable. CMS is also signaling a lower value for the device-supply codes.

Telehealth is the steadier news. The Consolidated Appropriations Act, 2026, signed February 3, extends the Medicare telehealth flexibilities through December 31, 2027. That is a two-year window after years of three-month extensions.

Weight-bearing CT pays for itself on volume, not on the demo

Two published analyses give the honest math, and both are a few years old.

Neither study says the scanner was a bad buy. Both say it pays back only when enough surgeons share it and keep ordering it. Reimbursement has moved since these numbers were gathered, so treat them as the shape of the answer, not the answer.

Your website attracts the patients it talks about

I review podiatry websites every week, and many of them open the same way: ingrown toenails, corns and calluses, and a stock photo of someone rubbing a heel. Then I get on the call with the doctor and hear a familiar complaint: the surgical schedule is thin, and the shockwave unit sits idle most afternoons.

The website is doing its job. It’s attracting exactly the patients it describes.

Patients read your homepage as a list of what you do, and Google reads it the same way. Whatever fills the top of the page shapes who calls. If routine care leads, routine care is what the front desk books. The procedures you trained longest for end up buried on a generic services page, two sentences each.

The fix is not a new website. It’s one good page at a time. Pick the procedure you most want to grow, whether that’s bunion correction, shockwave for plantar fasciitis, or custom orthotics. Give it its own page in plain language: who it helps, what recovery looks like, what it costs or how insurance handles it, and how to book. Then link to that page from the top of your homepage.

What minimally invasive bunion surgery costs in the first 35 cases

A systematic review of the minimally invasive hallux valgus learning curve put the plateau at a weighted mean of 35.5 cases, with a range of 27 to 40. During that phase, OR time and fluoroscopy shots rose significantly. Complications did not.

The case literature is less tidy. A March 2026 Podiatry Today review of single-screw technique ties many complications to surgical execution and reports that they fall as experience grows. Stiffness and recurrence lead the list, followed by transfer metatarsalgia, nonunion, malunion, first metatarsal shortening and hardware problems. The failures with one screw make me think a plate and screw construct could lower the complication rate. Nobody has tested that head to head in minimally invasive bunion surgery. The closest evidence compares one screw with two: a November 2025 systematic review found only two clinical studies, 162 feet in all. Correction and patient-reported outcomes were similar. One screw meant shorter cases, less fluoroscopy and fewer hardware removals; two screws held up better against rotation in the lab. The authors called the evidence too thin to recommend either. Plates have mostly been studied in open osteotomies, in small retrospective series. The plate question is open, and it is a study worth running.

No. 2 covered the HSS trial of 140 patients, which found minimally invasive and open Lapidus equivalent on PROMIS scores at one year. The question for most surgeons is no longer whether the technique works. It is what the first three dozen cases cost in time, radiation and patient selection.