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 […]
On November 3, ISASS submitted comments to Novitas Solutions Inc., the Medicare Administrative Contractor (MAC) covering Colorado, New Mexico, Oklahoma, Texas, Arkansas, Louisiana, Mississippi, Delaware, D.C., Maryland, New Jersey, and Pennsylvania, on its draft Local Coverage Determination (LCD) on Percutaneous Vertebroplasty and Vertebral Augmentation (Kyphoplasty). The comment letter focused on three aspects of the draft LCD: Proposed non-coverage of percutaneous sacral augmentation (0200T and 0201T) Proposed non-coverage of prophylactic use of percutaneous vertebroplasty Proposed non-coverage of treatment for more than two vertebral levels ISASS asked Novitas to revisit these issues prior to finalizing the LCD.
News and noteworthy information for October 2016: CMS Releases MACRA Final Rule Preparing Your Practice for MACRA CPT Editorial Panel – Summary of Panel Actions Palmetto Draft LCD: Noncovered Services Understanding the RUC Survey Instrument CMS Announces New Initiative to Improve Physician Experience with Medicare Deadline for Seeking Review of Potential Payment Penalties CMS Releases MACRA Final Rule On October 14, the Centers for Medicare and Medicaid Services (CMS) issued the final rule implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA was bipartisan legislation signed into law in April 2015 to permanently repeal the Sustainable Growth Rate (SGR), streamline physician quality reporting programs, and provide incentive payments for physician participation in alternative payment models. MACRA sunsets […]