From CMS developments to device coverage, here are 10 payer updates spine surgeons should know headed into 2026:
1. Some fee-for-service spine procedures in traditional Medicare will have prior authorizations added, according to CMS’ new Wasteful and Inappropriate Service Reduction model. CMS is partnering with AI and machine learning companies to test ways to implement an expedited prior authorization process for some Medicare services including spine and orthopedic services. Seventeen services will be targeted, including ones CMS says are vulnerable to fraud, waste and inappropriate use. They include epidural steroid injections for pain management, cervical spinal fusion, percutaneous image-guided lumbar decompression for spinal stenosis and percutaneous vertebral augmentation for vertebral compression fracture. Arthroscopy for knee osteoarthritis will also be affected. WISeR will run from Jan. 1, 2026, through Dec, 31, 2031.
2. President Donald Trump’s One Big Beautiful Bill Act, which includes Medicaid cuts, rural healthcare system investments and a temporary 2.5% Medicare Physician Fee Schedule boost for some cases, was signed July 4.
3. The first year of a bundled payment program for outpatient spine surgery was associated with lower spending compared to inpatient cases, according to a study published in JAMA Health Forum July 11. Bundled Payments for Care Improvement Advanced was associated with a differential reduction of $1,201 in total episode spending. Return inpatient admissions were 2.2% lower compared to hospitals that didn’t participate in bundles.
4. CMS’ released the’ 2026 proposed payment rule for hospital outpatient departments and ASC, and it includes the removal of 285 mostly musculoskeletal procedure codes from the inpatient-only list over a three-year period, including 266 codes for 2026.
5. CMS finalized changes to the physician fee schedule for 2026, including two separate conversion factors and a 3.6% increase in physician pay. The rule includes a conversion factor for qualifying alternative payment model participants and another for non-QPs.
6. CMS granted its New Technology Add-On Payment to Carlsmed’s aprevo implant for cervical spine surgery. Starting Oct. 1, cervical spine procedures done with aprevo will be eligible for additional payment from CMS and private insurers. The NATP will use unique ICD-10-PCS procedure codes to provide up to an additional $21,125 in reimbursement along with the Medicare Severity-Diagnosis Related Groups for qualifying inpatient cases.
7. MiRus’ Europa posterior cervical system earned CMS’ NTAP coverage. The system is used for the treatment of the cervical and upper thoracic spine and is built around the company’s 2.9 mm MoRe rod.
8. Centinel Spine earned one- and two-level lumbar disc replacement coverage from the second largest commercial payer in Arizona.
9. Health Care Service Corporation granted coverage for Boston Scientific’s Intracept procedure. Intracept is a minimally invasive treatment for chronic vertebrogenic low back pain, and HCSC’s coverage went into effect on Dec. 1.
10. CMS’ 2025 Final Rule included an increased payment for Intrinsic Therapeutics’ Barricaid device. The HCPCS procedure code C9757, created for lumbar discectomy with repair of annular defect using the Barricaid device received an increased payment from $6,500.62 to $9,527.15 in ASCs. Barricaid also earned a Category 1 CPT code from the American Medical Association in October. It has been used in more than 11,000 patients.
