On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) released the 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates proposed rule. CMS is accepting comments on the proposed rule through September 11, 2017. The final rule is expected to be released by November 1, 2017. (Please note that physician payment is made under the Physician Fee Schedule; hospitals are paid for outpatient services under the OPPS and ASCs are paid under the ASC payment system, both detailed in this rulemaking.) Please see the spine code spreadsheet for a comprehensive comparison of reimbursements for spine procedures in both the Hospital Outpatient and ASC settings from […]
On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2018. The PFS pays for services furnished by physicians and other practitioners in all sites of service. These services include but are not limited to visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. CMS will accept comments on the proposed rule until September 11, 2017, and will issue the final rule by November 1, 2017. As part of the proposed rule, CMS issues proposed values for new codes and codes deemed misvalued. Please see the spine code spreadsheet […]
On June 22, ISASS submitted a letter to Hayes in response to a Hayes Brief released December 29, 2016 reviewing sacroiliac joint fusion for treatment of low back pain. ISASS requested a meeting with Hayes to discuss the most current literature on the procedure as many of our members and their patients have experienced denials by insurers based on the Brief and its “C” rating.
On March 24, ISASS sent a letter to the Work Loss Data Institute requesting an update to the outdated Official Disability Guidelines for Sacroiliac Joint (SIJ) pain. ISASS takes issue with the current guidelines which support minimally invasive sacroiliac joint (MIS SIJ) fusion for conditions such as SIJ infection, tumor, and spondyloarthropathy, conditions for which high-quality evidence supporting superiority over non-surgical treatment is completely lacking. The guidelines dismiss two high-quality randomized trials in patients with chronic SIJ dysfunction showing superiority of MIS SIJ fusion over non-surgical treatment. ISASS requests revision of the guidelines to better reflect the level of available evidence and to follow standard scientific approaches to evidence interpretation. Click here to view the letter.