CMS is proposing eight new MS-DRGs to delineate single and multilevel lumbar fusions, according to a news release. These are expected to better track resource utilization for specific procedures and adjust hospital payments for resources behind multilevel fusions.
The other proposal is looking into an episode-based alternative payment model called the Transforming Episode Accountability Model. The TEAM model is expected to go into effect at the start of 2026. Participating hospitals will use it to manage total costs of care for spinal fusions and compare them to target CMS costs over four years.
CMS also released a new set of diagnostic codes to specifically describe intervertebral disc degeneration with discogenic pain. Those will take effect Oct. 1.
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