CMS pay cut for 26 spine surgeries included in 2021 proposal

Laura Dyrda -   Print  |

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.

More articles on spine surgery:

6 spine surgeons on the biggest obstacle they face going forward
North American Spine Society recognizes 20 spine surgeons under 40
Meet the Congress of Neurological Surgeons' president-elect

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