On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) released the 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates final rule. 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. For 2017, CMS is updating OPPS rates by 1.65 percent. After considering all other policy changes proposed under the OPPS, including estimated spending for pass-through payments, CMS estimates a 1.7 percent payment increase for hospitals paid under the OPPS in 2017. ASC payments are annually updated by the percentage […]
On November 2, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final 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, 2017. The PFS pays for services furnished by surgeons, 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. As part of the final rule, CMS assigned final values to the following new surgical spine codes set to take effect January 1, 2017: Code Descriptor 22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring […]
On November 1, HCSC (BCBS Illinois, BCBS Montana, BCBS New Mexico, BCBS Oklahoma, BCBS Texas) posted a draft updated lumbar fusion medical policy for comment through November 16. The draft policy establishes conditions for which lumbar spinal fusion may be considered medically necessary by HCSC. ISASS submitted comments specific to HCSC’s designation of lumbar fusion to treat degenerative disc disease (DDD) as not medically necessary and provided HCSC with a copy of the Society’s lumbar fusion policy. The final policy will be released by HCSC in the coming weeks.
ISASS Recommendations/Coverage Criteria for Decompression with Interlaminar Stabilization – Coverage Indications, Limitations, and/or Medical Necessity Authors: Richard Guyer, MD; Michael Musacchio, MD; Frank P. Cammisa, Jr., MD; and Morgan P. Lorio, MD, FACS This paper was originally published here. A PDF version of this Policy Statement can be accessed here. Introduction Broadly defined, lumbar spinal stenosis (LSS) is the progressive narrowing of the spinal canal and neural foramen resulting in pressure upon the nerve(s) leading to pain and/or numbness in the extremities, muscle weakness, bowel and bladder issues, and/or other pain related issues. However, the difficulty arises in that spinal stenosis is a heterogeneous condition with multiple etiologies which may present with disc height loss, facet hypertrophy, spondylolisthesis, retrolisthesis, coronal […]