Nikki Golden

May 29, 2019

CMS Updates Medicare Payment rates for Low Volume Procedures, Including Dozens of Spine Surgery Procedures

As part of CMS’ quarterly update for 3rd Quarter 2020, the Agency announced retroactive changes to the Professional Liability Insurance (PLI) Relative Values (RVUs) for dozens of procedures paid under the Medicare Physician Fee Schedule. The PLI RVUs are one of the three components, the other two being “work” and “practice expense” of the Medicare Total RVU for Physician payments for Medicare services.  The adjustments are positive for spine surgical procedures, varying from .50 RVUs to 1.50 RVUs. The updated payments will be automatically updated by Medicare for all Medicare claims made from July 1, 2019 through December 31, 2019, but was also made retroactive to January 1, 2019. Providers who billed Medicare for any of the CPT codes listed […]
May 3, 2019

ISASS asks CMS to consider C-code for Barricaid Implant system

ISASS sent the Center for Medicaid and Medicare Services a letter May 3, asking it to consider applying a C-code to the Barricaid Implant system. CMS C-codes are used for new technologies and new devices that are used in outpatient settings such as the Barricaid Implant system.  If approved, C-codes only apply to the facility payments, and physician payment and coding is separate.  Typically, technologies that gain C-code approval can see greater adoption and allow greater research and insight into outcomes and efficacy.  If approved, Barricaid would receive approval for C-code status for FY 2019. See the full text of the ISASS letter to CMS Regarding Barricaid System
April 30, 2019

ISASS Asks For Changes to National Correct Coding Initiative (NCCI) edits for Spinal Instrumentation Codes

In a letter dated April 16, 2019, ISASS asked for CMS to consider changes to a set of National Correct Coding Initiative (NCCI) edits for CPT codes 22842, Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure), 22843, Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure), 22844, Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (List separately in addition to code for primary procedure) 22845, Anterior instrumentation; 2 to 3 […]
April 30, 2019

CMS Proposes $195 Million Boost in Medicare Payments to Inpatient Rehabilitation Facilities in FY 2020

The Centers for Medicare & Medicaid Services (CMS) has released its proposed rule to update the Medicare inpatient rehabilitation facility (IRF) prospective payment system (PPS) for FY 2020. CMS projects that IRF PPS payments would rise by $195 million under the proposed rule. Specifically, CMS proposes a 2.5% increase factor, based on an IRF market basket update of 3.0% reduced by a 0.5 percentage point multifactor productivity adjustment. CMS proposes to rebase and revise the IRF market basket to use a 2016 base year rather than 2012. CMS also proposes to increase the outlier threshold amount from $9,402 for FY 2019 to $9,935 for FY 2020, which would have the effect of decreasing aggregate payments by approximately 0.2%. The proposed […]