How the CMS final payment rule will affect spine surgeons — 5 key notes

Written by Laura Dyrda | November 16, 2017 | Print  |

CMS released the 2018 final rule for the Medicare Physician Fee Schedule and payments for services provided in hospital outpatient departments and ASCs. The North American Spine Society outlined five ways 2018 changes will affect spine surgeons.

1. CMS agreed with NASS that CPT 27279 for percutaneous or minimally invasive sacroiliac joint fusion is misvalued and requested a Relative Value Update Committee review by October 2018, if not sooner to include it in the 2019 fee schedule proposed rule.

 

2. The Medicare Appropriate Use Criteria Program for Advanced Diagnostic Imaging was delayed by one year, with the new start date being Jan. 1, 2020, which would be an educational and operations testing year. CMS plans to pay claims for advanced diagnostic imaging regardless of whether the information is correct during the first year, and NASS encouraged physicians to begin voluntary participation in mid-2018.

 

3. CMS established a new modifier — -XY, for the technical component of X-rays using computed radiography technology — including X-ray as a component of a package service. CMS reduced payment by 7 percent from 2018 to 2022 and by 10 percent for 2023 and beyond.

 

4. One code was added to the ASC payable list: 22856 for total disc arthroplasty. NASS has been lobbying CMS to add appropriate procedures to ASCs and applauded the placement of both new codes for 2018.

 

5. The 2018 Medicare Physician Fee Schedule conversion factor will be $35.9996, a slight increase over last year, which was $35.89.

 

More articles on spine surgery:
The best advice for young spine surgeons at the beginning of their careers
4 key points on factors associated with lumbar spinal fusion 90-day readmissions
Dr. William Tally on the 2 biggest factors changing the spine field

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