Spine and orthopedic practices have two Medicare payment rules moving through the comment process at once this fall, both with direct implications for how procedures get reimbursed starting Jan. 1. Here are the key dates to track:
- Aug. 31: Comments due on CY 2027 OPPS/ASC proposed rule
CMS released the proposed rule for hospital outpatient and ASC payment July 2. It proposes a 2.4% average payment update for qualifying facilities, along with the addition of 618 codes to the ASC covered procedures list and the removal of 637 procedures from the inpatient-only list. Buried inside that average increase, however, is a cut to four of the highest-volume ASC pain procedures, including lumbar epidural steroid injections and radiofrequency ablation of the lumbar facet joints. Read more why that detail matters more to spine and pain practices than the top-line number suggests here.
- Sept. 14: Comments due on CY 2027 Medicare Physician Fee Schedule proposed rule
Released July 14, this rule cuts the physician conversion factor 1.68% for non-APM participants (to $32.8409) and 1.19% for qualifying APM participants (to $33.1693). Specialty-level estimates suggest orthopedic surgery payments could decline an additional 7% beyond the headline cut, with some joint-replacement procedures facing reductions up to 20%. CMS’ specialty impact table also projects a 5% overall decline for hand surgery and roughly 2% declines each for neurosurgery and interventional pain management. Read more on what this decline might mean for spine and orthopedic surgeons here.
- Early November: Final rules expected
Final rules are projected to be released in early November to satisfy the 60-day advance-notice requirement for major rules. This is the point where proposed cuts either get finalized, softened or, in some cases, reversed after industry comment.
- Jan. 1: Effective date for both rules
Barring congressional intervention, the finalized conversion factors, practice-expense changes and ASC covered-procedures updates take effect. Practices should have contracts, coding workflows and financial models updated before this date.
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.
