CMS pay cut for 26 spine surgeries included in 2021 proposal

Spine

CMS released the 2021 Proposed Medicare Physician Fee Schedule in August, which would reduce relative value unit conversion factor from $36.09 to $32.26.

The International Society for the Advancement of Spine Surgery compiled a list of spine procedures and how the RVU adjustment would affect payment rates. The RVU reduction along with code-specific adjustments reduced Medicare payment for spine procedures between 5 percent and 12 percent when compared with 2020 rates.

Here is a list of 26 procedures and the proposed 2021 payment rate, as well as the year-over-year pay rate decrease. Note: all procedure codes would have reduced payment; this list includes the rate for 26 common codes.

1. Remove part of neck vertebra (22100): $826.19 (-$64.50)
2. Remove part of lumbar vertebra (22102): $793.29 (-$60.23)
3. Remove extra spine segment (22103): $133.56 (-$14.05)
4. Treat spine fracture (22325): $1,401.72 (-$113.68)
5. Treat neck spine fracture (22326): $1,437.53 (-$125.15)
6. Lateral lumbar spine fusion (22533): $1,577.54 (-$156.21)
7. Neck spine fusion (22548): $1,876.59 (-$162.11)
8. Neck spine fusion (22554): $1,203.32 (-$107.82)
9. Thorax spine fusion (22556): $1,589.15 (-$149.64)
10. Lumbar spine fusion (22558): $1,460.11 (-$141.91)
11. Neck spinal fusion (22595): $1,444.95 (-$124.95)
12. Neck spine fusion (22600): $1,240.42 (-$105.36)
13. Thorax spine fusion (22610): $1,219.77 (-$103.28)
14. Lumbar spine fusion (22612): $1,513.99 (-$146.14)
15. Insert spine fixation device (22843): $773.61 (-$81.72)
16. Insert spine fixation device (22844): $935.88 (-$97.73)
17. Insert spine fixation device (22845): $690.37 (-$73.64)
18. Insert spine fixation device (22846): $717.80 (-$76.54)
19. Insert spine fixation device (22847): $759.41 (-$86.17)
20. Remove spine fixation device (22850): $702.63 (-$58.50)
21. Remove spine fixation device (22852): $674.89 (-$55.92)
22. Cervical artificial discectomy (22856): $1,557.54 (-$152.39)
23. Lumbar artificial discectomy (22857): $1,679.80 (-$171.59)
24. Revise cervical artificial disc (22861): $2,215.01 (-$202.64)
25. Revise lumbar artificial disc (22862): $2,213.39 (-$197.39)
26. Fusion of sacroiliac joint (27280): $1,296.87 (-$118.56)

ISASS plans to provide comments to the CMS final rule.

Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Webinars

Featured Podcast

Featured Whitepapers