Aetna's reimbursement policy for structural allografts in cervical arthrodesis is concerning two leaders at the International Society for Advancement of Spine Surgery.
Morgan Lorio, MD, and Luis Tumialan, MD, call on Aetna to revisit its reimbursement policy, in the organization's Winter 2024 edition of Vertebral Columns. Current policy for CPT code 20931 is limited to a single use for structural allografts during cervical arthrodesis even if more are needed during a case.
But another CPT code exclusively for cage use provides higher reimbursement and can be reported multiple times. Dr. Lorio and Dr. Tumialan said this distinction may compromise patient care.
"This policy not only presents a financial burden for surgeons but, more importantly, it limits the surgeon’s ability to make decisions in the best interest of their patients," the spine surgeons wrote. "By creating a financial incentive to favor allografts, which may not always be the most appropriate choice for a given patient, insurers like Aetna are compromising the doctor-patient relationship and the over- all quality of care that patients receive."
Drs. Lorio and Tumialan are members on the ISASS Executive Board of Directors. A spokesperson for Aetna declined an opportunity to comment.