CMS Medicare Physician Fee Schedule Final Rule Increases Value for Minimally Invasive SI Joint Spine Fusion

Vertebral Columns – Fall 2019
November 1, 2019
CMS Issues Final Rule for 2020 Medicare Physician Fee Schedule
November 30, 2019

In the 2020 Medicare Physician Fee Schedule Final Rule, released on Nov. 1, CMS finalized a work RVU of 12.13 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. The current (2019) work RVU for 27279 is 9.03 so the increase is 3.10 or approximately 33%.  In addition, the Total RVUS for CPT 27279 changed from 2019 to 2020 from 19.99 to 25.34. These increases have long been advocated by ISASS and other stakeholders.

ISASS had submitted comments to CMS on the 2020 Medicare Physician Fee Schedule Proposed Rule in September, where CMS indicated a proposed value of 9.03 work RVU. At that time, CMS was 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 originally reviewed in 2014, prior to ISASS becoming a member of the AMA House of Delegates. Since then, ISASS has argued to CMS and the AMA Relative Value Updated Committee (RUC) that the 2014 value was inappropriate and inaccurately based on a flawed comparison to a discectomy procedure (CPT code 62287, Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar). ISASS presented CMS with results from a Rasch Analysis and other quality data, which led CMS to formally list 27279 as potentially misvalued in consecutive Medicare Physician Fee Schedule Final Rules in 2016 and 2017 and requested the AMA RUC to re-evaluate 27279 as potentially misvalued. The AMA RUC reviewed the request from societies, including ISASS, and provided a recommendation to CMS to maintain the 9.03 value, but ISASS stated in its comment letter that this value is vastly too low.

The written comments from ISASS was consistent with comments and data submitted previously to CMS as well as the White House Office of Management and Budget (OMB) requesting increases in RVUS for 27279, which were led by ISASS Coding and Reimbursement Task Force Chairman Morgan Lorio, MD, who worked diligently to correct the valuation for this procedure.

Read the 2020 Medicare Physician Fee Schedule Final Rule here.