September 10, 2020

CMS Issues Proposed Rule for 2021 Medicare Physician Fee Schedule: Specific Impact to Spine Procedures

CMS Issues Proposed Rule for 2021 Medicare Physician Fee Schedule: Specific Impact to Spine Procedures PHYSICIAN PAYMENT PROVISIONS The 2021 Proposed Medicare Physician Fee Schedule Rule updated several policies and payment rates of relevance to ISASS members. Notably, budget neutrality adjustments have reduced the Conversion Factor associated with all CPT codes, from $36 per relative value unit (RVU) to $32 per RVU. This reduction, along with other code-specific adjustments, has impacted spine procedures by decreasing Medicare payments between 5% and 12%, compared with calendar year (CY) 2020 final rates. Public comments are being accepted by Centers for Medicare & Medicaid Services (CMS) between now and 5pm Eastern on October 5. Comments may be submitted electronically via this link. ISASS encourages its […]
September 10, 2020

ISASS Comments on Independence Blue Cross Spinal Fusion Policy

ISASS Comments on Independence Blue Cross Spinal Fusion Policy On August 25, 2020, ISASS sent a comment letter to Independent Blue Cross (IBC), the Blue Cross affiliate for the Greater Philadelphia area, regarding their recent Spinal Fusion Policy. The IBC policy calls for attestation of failure of conservative treatment by a physiatrist.  The letter from Dr. Frank Phillips, ISASS president, stated “ISASS believes that this intrusion has already been shown to create significant barriers to efficient care. ISASS questions the Level of Evidence supporting an additional consultation with a physiatrist to document that a patient has exhausted nonsurgical options. ISASS further maintains that the spine surgeon, rather than the physiatrist, is solely capable of the surgical decision making required to […]
August 7, 2020

ISASS Comments on Washington State Health Care Authority Potential Review of Sacroiliac Joint Fusion Policy

ISASS Comments on Washington State Health Care Authority Potential Review of Sacroiliac Joint Fusion Policy On July 23, 2020, ISASS sent a comment letter to the Washington State Health Care Authority (HCA) regarding their sacroiliac joint fusion coverage policy, which is used by the state’s Medicaid and workers’ compensation program for coverage. The ISASS letter asked that the Washington HCA consider review and potential revision of their coverage policy to include minimally invasive sacroiliac joint fusion for joint pain and dysfunction due to degenerative conditions not limited to direct trauma or injury to the pelvic girdle, which would be consistent with ISASS recommendations. The current Washington State HCA policy does not recommend coverage, despite an initial positive finding by the […]
August 7, 2020

ISASS Supports Letter to the HHS Requesting Elimination of Budget Neutrality Adjustments to Physician Payments for 2020

ISASS Supports Letter to the HHS Requesting Elimination of Budget Neutrality Adjustments to Physician Payments for 2020 On July 1, 2020, multiple organizations, including ISASS, sent a letter to Alex Azar, secretary of Health and Human Services (HHS), to remove budget neutrality negative adjustments under the 2021 Medicare Physician Fee Schedule. The organizations indicated support for the actions of the Centers for Medicare and Medicaid Services (CMS) in last year’s Medicare physician payment final rule to utilize the American Medical Association (AMA) Current Procedural Terminology Editorial Panel coding framework, and the AMA Specialty Society Relative Value Scale Update Committee recommended values for office and outpatient visits starting January 1, 2021. The framework was the result of significant collaboration by an […]