September 30, 2019

ISASS Comments on Medicare Physician Fee Schedule CY 2020 Proposed Rule, Address Misvaluation of 27279

On September 23, ISASS submitted comments to the Centers for Medicare and Medicaid Services (CMS) on their proposed rule for CY 2020 for the Medicare Physician Fee Schedule (released on July 29). The ISASS letter addressed several issues of relevance to ISASS member reimbursement regulation, including the Medicare payment 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. In the proposed rule, CMS indicated a proposed value of 9.03 work RVU, but that 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 […]
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 […]