CMS Releases 2017 Final Physician Fee Schedule

ISASS Submits Comments to HCSC on Draft Lumbar Fusion Policy
November 17, 2016
CMS Releases 2017 Final Hospital Outpatient and ASC Rule
November 22, 2016
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On November 2, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies, payment rates and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. The PFS pays for services furnished by surgeons, physicians, and other practitioners in all sites of service. These services include but are not limited to visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services.

As part of the final rule, CMS assigned final values to the following new surgical spine codes set to take effect January 1, 2017:

Code Descriptor
22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges) when performed to intervertebral disc space in conjunction with interbody arthrodesis, each interspace
22854 Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges) when performed to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect
22859 Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect
22867 Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level
22868 Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level
22869 Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level
22870 Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level
62380 Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar

 

Additionally, after receiving substantial pushback from the physician community and medical societies including ISASS, CMS finalized a data collection strategy for surgical codes with 10- and 90-day global periods that significantly reduces the burden on surgeons and their practices compared to the proposed rule.

A full summary of the final rule is available here. A spreadsheet comparing spine code values and reimbursements from 2016 to 2017 is available here. The final rule goes into effect on January 1, 2017.