DeGen Medical issued a statement in support of the new CMS inpatient classification codes for custom-made lumbar fusion devices set to take effect in fiscal 2027, according to an Aug. 25 news release from the devicemaker.
“CMS has now established permanent coding that specifically describes custom-made, anatomically and virtually designed interbody fusion devices,” Craig Black, CEO of DeGen Medical, said in the release. “We believe this recognizes the growing importance of truly individualized solutions in spine surgery.”
Beginning Oct. 1, CMS will implement new inpatient MS-DRGs 523, 524 and 525 for extensive or complex spinal fusion procedures, excluding cervical. The fiscal 2027 framework also includes ICD-10-PCS procedure codes describing the use of a custom-made, anatomically and virtually designed interbody fusion device in qualifying lumbar, lumbosacral and thoracolumbar fusion procedures — a category DeGen said applies to its patient-specific implants.
CMS created the new DRG family after separate requests from SI-Bone and Carlsmed, each seeking reassignment of cases using their own implants into higher-paying DRGs. Rather than granting either request individually, CMS built a shared classification covering extensive fusion cases involving either device, or both.
Carlsmed and SI-Bone have both cast their support toward CMS’ decision, with SI-Bone’s CEO calling the development a tailwind in its most recent financial projections.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
