Spine surgery and ASCs: 8 notes


Spine surgery is a specialty that continues to grow in ASCs, and many physicians see a bright future for the outpatient setting as minimally invasive techniques and patient demand grow.

Eight points on spine surgery and ASCs.

1. There are more than 180 ASCs in the U.S. that offer minimally invasive spine surgery.

2. Anterior cervical discectomy and fusion costs significantly less at an ASC than a hospital outpatient department or Medicare and privately insured patients, according to a study published in the Dec. 15 edition of Spine. Total costs for spinal fusion in the ASC at one year were $5,879.46, compared with $12,873.97 for procedures in the hospital, researchers found.

3. A small study from Newport Beach, Calif.-based Hoag Orthopedics found more patients preferred to have spine surgery at an ASC than a hospital. Of 58 people surveyed, 30 said they would prefer to undergo a spine operation in the ASC, while 28 said they would prefer to undergo surgery in a hospital.

4. The prevalence of minimally invasive spine surgery will likely push more spinal fusions into the ASC.

"Traditionally, laminectomies and ACDFs were performed comfortably in ASCs," Dr. Alok Sharan, of Spine and Performance Institute in Edison, N.J., said. "As incisions became smaller and anesthesia improved, there has been a slow migration of lumbar fusions to ASCs. As regional anesthesia becomes more prevalent, we will see that surgeons will become more comfortable performing single- and two-level lumbar fusions in the ASC."

5. CPT code 2255 (arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below c2) is one of the procedures to get higher average Medicare reimbursement in an ASC or HOPD with $1,686.33. CPT code 63685, for Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling, is on the lower end with $336.61.

6. Four of the 10 most common procedures done in ASCs are spinal injections.

7. Bundled payments from private insurers were a viable option for lumbar spinal fusion patients, researchers found. A study published in the January 2024 issue of Spine,  looked at lumbar spinal fusion patients from October 2018 to December 2018 who used CMS' Bundled Payments for Care Improvement Advance model, and compared that data with private bundle data from 2018 to 2020 to analyze the transition away from BPCI-A. They concluded that bundled payments can be successful in lumbar spinal fusions and that "constant price adjustment is necessary so bundled payments remain financially beneficial to both parties and systems overcome early losses."

8. CMS and private insurers are taking a closer look at prior authorizations. A CMS rule going into effect in 2026 would require some insurers to turnaround prior authorization decisions sooner. Meanwhile UnitedHealthcare in September began its two-phased approach to eliminating prior authorization requirements.

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