July 1 too soon for new spine prior authorization rules, surgeons tell CMS


Medical device companies and surgeons are banding together to ask CMS to roll back new prior authorization requirements set to go into effect July 1.

In an April 7 letter, 40 stakeholders — including the Medical Device Manufacturers Association, the North American Spine Society and the American Academy of Orthopaedic surgeons — outlined how the incoming regulations will decrease access to care.

Beginning July 1, CMS will require prior authorization for two new service categories: cervical fusion with disc removal and implanted spinal neurostimulators. The agency said it plans to use the prior authorization to ensure Medicare patients receive necessary care and reduce "unnecessary increases in the volume" of covered outpatient spine services.

But stakeholders said the new regulations will delay patient access to "medically necessary care."

Other concerns raised included a lack of experience in using prior authorization in fee-for-service Medicare, a lack of administrative structure for implementing the policy and a lack of guidelines through which providers would obtain prior authorization, according to the letter.

In a Dec. 29 letter to former CMS Administrator Seema Verma, the International Society for the Advancement of Spine Surgery said prior authorization for neurostimulators would lead to more opioid use and negative physical and clinical outcomes for Medicare patients.

"We believe it is essential to continue to increase access to nonopioid pain treatment. Spinal cord stimulation and cervical fusion surgery are especially important alternatives to opioid prescriptions," according to the spine surgery society.

Stakeholders asked CMS to delay the proposed expansion of prior authorization until it has conducted a detailed analysis of the five procedures that it required prior authorization for last year in its outpatient prospective payment system/ASC final rule.

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