Public Policy

August 29, 2019

UPDATED: ISASS Urges Changes to NCCI Edits for Spine Surgery

In a letter dated Aug. 16, ISASS responded to a decision by CMS and CMS’ NCCI Edit Contractor, Capital Bridge LLC, to not revise a set of  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 […]
August 29, 2019

Proposed Rule Comment Period Opportunity for 27279, Minimally Invasive SI Joint Fusion

In the Medicare Physician Fee Schedule Proposed Rule, released by the Centers of Medicare and Medicaid Services (CMS) on July 29, CMS proposed a recommended work Relative Value Unit (RVU) of 9.03 of CPT code 27279, Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed and placement of transfixing device. In the proposed rule, CMS indicated they were seeking comment on whether to adopt a work RVU of 20.00, which is the work RVU for CPT code 27280, Arthrodesis, open, sacroiliac joint, including obtaining bone graft, including instrumentation, when performed to achieve site-of-service parity and eliminate incentives for facilities to use a higher-valued procedure. CPT 27279 for MIS SIJ Fusion was […]
August 28, 2019

CMS Issues Final Rule on Inpatient Prospective Payment System

On Aug. 2, CMS finalized policy changes to spur competition and innovation that will help deliver improved care and outcomes at a better value to patients. The final rule updates Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year 2020 and advances two key CMS priorities—“Rethinking Rural Health” and “Unleashing Innovation” by making historic changes to how Medicare pays hospitals. This final rule: Increases the wage index for certain low-wage index hospitals, including many rural hospitals Increases Medicare add-on payments for high-cost eligible new technologies from 50% to 65% Clarifies policies on “substantial clinical improvement” to qualify for new technology add-on payments Provides an […]
August 28, 2019

CMS Issues Final Rule on Inpatient Rehabilitation Facilities

On July 31, CMS issued a final rule that updates Medicare payment policies and rates for facilities under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) and the IRF Quality Reporting Program for fiscal year 2020. CMS is continuing ts efforts toward the eventual transition to a unified post-acute care system through updates to the data used for IRF payments, including revising the Case-Mix Groups (CMGs), updating the CMG relative weights and average length of stay values, and using concurrent inpatient prospective payment system wage index data for the IRF PPS to align wage index data across settings of care. For fiscal year 2020, CMS is finalizing updates to the IRF PPS payment rates using the most recent data to reflect […]