July 31, 2019

Centers for Medicare and Medicaid Services Issues a Proposed Rule for the 2020 Outpatient Prospective Payment System

On July 29, CMS published the proposed Physician Fee Schedule Rule for the 2020 Outpatient Prospective Payment System. The proposed changes encourage site-neutral payment between certain Medicare sites of services as well as proposing updates and policy changes under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. According to CMS, the proposed polices in the CY 2020 OPPS/ASC Payment System proposed rule would further advance the agency’s commitment to increasing price transparency—including proposals for requirements that would apply to each hospital operating in the United States)—rethinking rural health, unleashing innovation, reducing provider burden, and strengthening program integrity so that hospitals and ambulatory surgical centers can operate with better flexibility, and patients have what […]
July 30, 2019

CMS Proposes to Maintain Current Value for Minimally Invasive SI Joint Spine Fusion But Will Consider Alternative Values

In the July 29, Medicare Physician Fee Schedule Proposed Rule, CMS indicated a proposed value for 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 of 19.88 Total RVUS which maintains the current value of 27279. ISASS had previously asked CMS to reconsider the value of this CPT code as “misvalued,” and CMS agreed that it may be misvalued and assigned a review of the value by the AMA RUC.  ISASS, along with other medical societies—icluding NASS, AANS, and AAOS—conducted a physician survey and recommended increasing the RVUs for 27279.  The RUC, however, did not accept this recommendation and CMS cited the RUC’s […]
July 30, 2019

Centers for Medicare and Medicaid Services (CMS) Issues a Proposed Rule for 2020 Medicare Physician Fee Schedule

On July 29, CMS published the proposed Physician Fee Schedule Rule for 2020. In the proposed rule, the Centers for Medicare and Medicaid Services (CMS) has proposed several changes that will affect ISASS members: With the budget neutrality adjustment to account for relative value changes, as required by law, the proposed 2020 PFS conversion factor is $36.09, a slight increase above the 2018 PFS conversion factor of $36.05. CMS proposed payments for new structural allograft codes used in orthopaedic trauma and oncology services (new CPT codes, 209X3, Osteoarticular Allograft, 209X4, Hemicortical Intercannulary Allograft, and 209X5, Interarticular Intercannulary Allograft Complex) CMS proposed updated payments for plain film X-ray codes for spine (CPT codes 72020-72220) CMS proposed updated payments for Patient Office […]
July 30, 2019

U.S. Centers for Medicare and Medicaid Innovation Invites Applicants for New Direct Contracting Voluntary Payment Model

The Centers for Medicare and Medicaid Innovation (CMMI) has announced a series of new voluntary payment models and are seeking facilities and organizations interested in participating to submit an initial Level of Interest (LOI) by Friday, August 2. One of the models being tested is a Direct Contracting model. This model is one of a set of three voluntary payment model options aimed at reducing expenditures and preserving or enhancing quality of care for beneficiaries in Medicare fee-for-service (FFS). The payment model options create opportunities for a broad range of organizations to participate with the Centers for Medicare & Medicaid Services (CMS) in testing the next evolution of risk-sharing arrangements to produce value and high-quality health care. Building on lessons learned […]