CMS raises MIS SI joint fusion physician reimbursement 25%: 5 key notes


The Centers for Medicare and Medicaid Services issued the 2016 Hospital Outpatient Prospective Payment System recommendation for sacroiliac joint fusion, increasing the outpatient payment when billing the CPT 27279.

Here are five key notes:


1. The payment will increase from $9,266 to $10,538, a 14 percent increase.


2. The new payment will be effective Jan. 1, 2016.


3. The fee schedule also increases physician reimbursement for the procedure from $577 to $722, a 25 percent increase.


4. At the same time, the Wisconsin Physician Services Medicare Administrative Contractor covering five Midwestern states issued a positive local coverage determination update for MIS SI joint fusion beginning Dec. 17, 2015. Those states include Iowa, Indiana, Kansas, Michigan, Missouri and Nebraska.


5. Currently, MIS SI joint fusion is available in 49 out of 50 states for 48 million Medicare beneficiaries. Two additional MACs released positive draft LCDs for the procedure, including National Government Services and CGS Administrators.


"Once these three MACs implement coverage, seven of the eight MACs will have positive coverage for MIS SI joint fusion for over 98 percent of Medicare beneficiaries in the United States," said Jeffrey Dunn, president and CEO of SI-BONE. "We believe that the clinical and economic evidence supporting the iFuse Implant System as a safe and effective treatment for patients suffering from degenerative scaroiliitis or SI joint disruption has demonstrated that these patients deserve access to the procedure."


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