In the last month, Becker’s reported on six developments in CMS and Medicare news affecting spine surgery and physicians.
1. Some fee-for-service spine procedures in traditional Medicare will have prior authorizations added, according to CMS’ new Wasteful and Inappropriate Service Reduction model. CMS is partnering with AI and machine learning companies to test ways to implement an expedited prior authorization process for some Medicare services including spine and orthopedic services. Seventeen services will be targeted, including ones CMS says are vulnerable to fraud, waste and inappropriate use. They include epidural steroid injections for pain management, cervical spinal fusion, percutaneous image-guided lumbar decompression for spinal stenosis and percutaneous vertebral augmentation for vertebral compression fracture. Arthroscopy for knee osteoarthritis will also be affected. WISeR will run from Jan. 1, 2026, through Dec, 31, 2031.
2. President Donald Trump’s One Big Beautiful Bill Act, which includes Medicaid cuts, rural healthcare system investments and a temporary 2.5% Medicare Physician Fee Schedule boost for some cases, was signed July 4. The move has yielded mixed reactions from spine surgeons.
3. The first year of a bundled payment program for outpatient spine surgery was associated with lower spending compared to inpatient cases, according to a study published in JAMA Health Forum July 11. Bundled Payments for Care Improvement Advanced was associated with a differential reduction of $1,201 in total episode spending. Return inpatient admissions were 2.2% lower compared to hospitals that didn’t participate in bundles.
4. CMS is floating changes to the physician fee schedule for 2026, including two separate conversion factors and a 3.6% increase in physician pay. The July 14 proposal includes a conversion factor for qualifying alternative payment model participants and another for non-QPs. The QP conversion factor is proposed to increase by 0.75% and 0.25% for non-QPs. Another proposed change includes a one-time 2.5% statutory increase and an estimated 0.55% adjustment for proposed changes to work relative value units. The proposed QP conversion factor will be $33.59 — a $1.24 increase (3.83%) from $32.35 — and the non-QP rate will be $33.42, up $1.17 or 3.62%.
5. CMS released the 2026 proposed payment rule for hospital outpatient departments and ASC, and it includes the removal of 285 mostly musculoskeletal procedure codes from the inpatient-only list over a three-year period, including 266 codes for 2026.
6. DISC Surgery Center at Marina del Rey (Calif.) is now in-network with Medicare. The ASC went in-network after meeting all qualifying health and safety standards under Conditions for Coverage. DISC Surgery Center at Marina del Rey was AAAHC accredited when it opened in 2023.
