2013 Physician Fee Schedule Finalized – CMS Assigns Valuation to Pre-Sacral Fusion Code

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ISASS Thanks our Members for Stepping Up

On November 1st, the Centers for Medicare & Medicaid Services (CMS) released the 2013 Medicare Physician Fee Schedule final rule.

Of particular note to ISASS members is CMS’ decision to assign a valuation (‘relative value units’) to a recently approved Category I CPT® code 22586: pre-sacral interbody fusion at L5-S1. Earlier this year, ISASS assisted the AMA in determining the surgical valuation for the transition of this procedure code to Category I status from its Category III status since the procedure had satisfied the criteria necessary for such a code transition. After the Editorial Panel had voted in favor of establishing the Category I code for pre-sacral interbody fusion, other spine-related medical societies declined to participate in a member RUC survey to establish physician valuation for the procedure. ISASS however realized the importance of appropriately valued procedures to its spine surgeon members, and agreed to conduct a survey of our members to collect the appropriate data for CMS to establish valuation for this procedure.

Thanks to an active and engaged ISASS membership, we conducted a survey consistent with the standards set forth by the AMA/Specialty Society RVS Committee (the RUC) for CPT code 22586 and provided those results to CMS to better inform their decision-making. Without our members willingness to participate in this survey, CMS would not have any information by which to establish valuation of this code and payment for this procedure would be left to carrier discretion. The final, CMS-approved valuation for this procedure is consistent with the data that ISASS and its members provided earlier this year.

ISASS has no preference for a particular device. We do know that some of our members are using this device and we are acting in the interest of those members and their patients.

We look forward to continuing to engage our members on coding and reimbursement issues relevant to spine surgeries, and we hope to have a positive impact on our members practice as we prepare to become formally engaged with the AMA House of Delegates.

CMS also finalized other rules on November 1st; one would increase Medicare payments to hospital outpatient departments by 1.8 percent in 2013 and increase payments to ambulatory surgery centers by 0.6 percent. In subsequent newsletter issues, ISASS will report further on the final rule and all of its provisions impacting spine surgeries.