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HCSC/BCBSIL’s draft policy is moderately onerous in the sense that most indications for a spinal fusion are still covered. The areas where lumbar spinal fusions procedures “are not considered medically necessary” include patients where the sole indication is a disc herniation or neuro structure compression (initial discectomy/laminectomy) “as well as” degenerative disc disease and facet syndrome. This is the area where the primary controversy exists. While many patients with degenerative disc disease or facet syndrome will not have that diagnosis as their sole indication, there are patients with chronic low back pain who have not responded to appropriate non-operative treatment and who will benefit from a surgical procedure. Those patients may now lose the opportunity of a clinically meaningful improvement. […]

Earlier this week, HCSC, the parent corporation for Blue Cross/Blue Shield plans in Illinois, New Mexico, Oklahoma, and Texas, issued a new draft policy for Lumbar Spinal Fusions. Concerns have been raised that this new policy rules out access to lumbar fusion for patients where the sole indication is a disc herniation or neurostructure compression (initial discectomy/laminectomy), and patients with a sole indication of degenerative disc disease or facet syndrome. To review this draft policy, please Click Here ISASS is currently conducting a review of this proposed policy, and expects to issue comments to HCSC prior to the May 31st comment deadline, accompanied by our evidence-based Policy Statement on Lumbar Fusion Surgeries. However, it is very important that HCSC hear from surgeons […]

ISASS President Steven Garfin, MD, has written a response to the Centers for Medicare & Medicaid Services Division of Outpatient care regarding agency considering the removal of cervical disc arthroplasty from the Medicare “Inpatient Only” list. The letter is copied below and is also available in PDF format. Download PDF Version April 20, 2012 John McInnes, MD, JD1 Director, Division of Outpatient Care – C4-01-15 Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Dear Dr. McInnes: I am writing to you and CMS on behalf of the International Society for the Advancement of Spine Surgery (ISASS). ISASS is an international, scientific, and educational society organized to discuss and assess existing strategies and innovative ideas in the […]