CMS Updates Medicare Payment rates for Low Volume Procedures, Including Dozens of Spine Surgery Procedures

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As part of CMS’ quarterly update for 3rd Quarter 2020, the Agency announced retroactive changes to the Professional Liability Insurance (PLI) Relative Values (RVUs) for dozens of procedures paid under the Medicare Physician Fee Schedule. The PLI RVUs are one of the three components, the other two being “work” and “practice expense” of the Medicare Total RVU for Physician payments for Medicare services.  The adjustments are positive for spine surgical procedures, varying from .50 RVUs to 1.50 RVUs.

The updated payments will be automatically updated by Medicare for all Medicare claims made from July 1, 2019 through December 31, 2019, but was also made retroactive to January 1, 2019. Providers who billed Medicare for any of the CPT codes listed below since January 1, 2019 can seek retrospective payments through the local Medicare Administrative Contractor (MAC).

The following codes are relevant for ISASS members.

  • 22112, Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; thoracic
  • 22114, Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; lumbar
  • 22222, Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracic
  • 22319, Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting
  • 22548, Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without excision of odontoid process
  • 22586, Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace
  • 22812, Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segments
  • 22818, Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); single or 2 segments
  • 22819, Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); 3 or more segments
  • 22847, Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure)
  • 22857, Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar
  • 22861, Revision, including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical
  • 22864, Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical
  • 22865, Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar
  • 63066, Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; each additional segment (List separately in addition to code for primary procedure)
  • 63078, Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, each additional interspace (List separately in addition to code for primary procedure)
  • 63170, Laminectomy with myelotomy (eg, Bischof or DREZ type), cervical, thoracic, or thoracolumbar
  • 63180, Laminectomy and section of dentate ligaments, with or without dural graft, cervical; 1 or 2 segments
  • 63182, Laminectomy and section of dentate ligaments, with or without dural graft, cervical; more than 2 segments
  • 63190, Laminectomy with rhizotomy; more than 2 segments
  • 63197, Laminectomy with cordotomy, with section of both spinothalamic tracts, 1 stage; thoracic
  • 63250, Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; cervical
  • 63251, Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracic
  • 63252, Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracolumbar
  • 63270, Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; cervical
  • 63273, Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; sacral
  • 63278, Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, sacral
  • 63283, Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, sacral
  • 63285, Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, cervical
  • 63287, Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, thoracolumbar
  • 63290, Laminectomy for biopsy/excision of intraspinal neoplasm; combined extradural-intradural lesion, any level
  • 63295, Osteoplastic reconstruction of dorsal spinal elements, following primary intraspinal procedure (List separately in addition to code for primary procedure)
  • 63301, Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by transthoracic approach
  • 63302, Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, thoracic by thoracolumbar approach
  • 63004, Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, cervical
  • 63306, Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, thoracic by thoracolumbar approach
  • 63700, Repair of meningocele; less than 5 cm diameter
  • 63704, Repair of myelomeningocele; less than 5 cm diameter
  • 63706, Repair of myelomeningocele; larger than 5 cm diameter
  • 63740, Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; including laminectomy
  • 63746, Removal of entire lumbosubarachnoid shunt system without replacement

Read the CMS Manual System Update: CMS Quarterly Update 7-1-19 MPRVU Correction 5-3-19