71 spine procedures CMS may not pay for at ASCs in 2022

Alan Condon -   Print  | Email

ASC administrators are dismayed by CMS' proposal to bump 298 musculoskeletal-related procedures back to its inpatient-only list next year.

The proposal has been described as "an obvious step backwards" by administrators who question how much data CMS has collected to back up the "patient safety concerns" cited as the reason to remove the 298 procedures from its IPO list.

It has been less than a year since CMS removed the 298 procedures from its IPO list, with many surgery centers closed early in 2021 because of the COVID-19 pandemic.

The procedures that could be bumped back to the IPO list, which CMS has also proposed to reinstate, primarily relate to knee, hip, shoulder and spine. 

Here are the 71 spine-related procedures and their codes that CMS may not pay for at ASCs next year:

Note: CPT codes and descriptions, available on CMS' website, are subject to copyright of the American Medical Association.

CY 2021 CPT Code

CY 2021 Short Descriptor

CY 2021 Long Descriptor

00604

Anesth sitting procedur

Anesthesia for procedures on cervical spine and cord; procedures with patient in the sitting position

0095T

Rmvl artific disc addl crvcl

Removal of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (list separately in addition to code for primary procedure)

0098T

Rev artific disc add

Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (list separately in addition to code for primary procedure)

0163T

Lumb artif discectomydiskectomy addl

Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), each additional interspace, lumbar (list separately in addition to code for primary procedure)

0164T

Remove lumb artif disc add

Removal of total disc arthroplasty, (artificial disc), anterior approach, each additional interspace, lumbar (list separately in addition to code for primary procedure)

0165T

Revise lumb artif disc addl

Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, lumbar (list separately in addition to code for primary procedure)

0202T

Post vert arthrplst 1 lumba

Posterior vertebral joint(s) arthroplasty (for example, facet joint[s] replacement), including facetectomy, laminectomy, foraminotomy, and vertebral column fixation, injection of bone cement, when performed, including fluoroscopy, single level, lumbar spine

0219T

Plmt post facet implt cerv

Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; cervical

0220T

Plmt post facet implt thor

Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; thoracic

0220T

Plmt post facet implt thor

Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; thoracic

22010

I&d p-spine c/t/cerv-thor

Incision and drainage, open, of deep abscess (subfascial), posterior spine; cervical, thoracic, or cervicothoracic

22015

I&d abscess p-spine l/s/ls

Incision and drainage, open, of deep abscess (subfascial), posterior spine; lumbar, sacral, or lumbosacral

22110

Remove part of neck vertebra

Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; cervical

22112

Remove part thorax vertebra

Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; thoracic

22114

Remove part lumbar vertebra

Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; lumbar

22116

Remove extra spine segment

Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; each additional vertebral segment (list separately in addition to code for primary procedure)

22206

Incis spine 3 column thorac

Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (for example, pedicle/vertebral body subtraction); thoracic

22207

Incis spine 3 column lumbar

Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (for example, pedicle/vertebral body subtraction); lumbar

22208

Incis spine 3 column adl seg

Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (for example, pedicle/vertebral body subtraction); each additional vertebral segment (list separately in addition to code for primary procedure)

22210

Incis 1 vertebral seg cerv

Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; cervical

22212

Incis 1 vertebral seg thorac

Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracic

22214

Incis 1 vertebral seg lumbar

Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar

22216

Incis addl spine segment

Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (list separately in addition to primary procedure)

22220

Incis w/discectomy cervical

Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervical

22222

Incis w/discectomy thoracic

Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracic

22224

Incis w/discectomy lumbar

Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbar

22226

Revise extra spine segment

Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (list separately in addition to code for primary procedure)

22318

Treat odontoid fx w/o graft

Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; without grafting

22319

Treat odontoid fx w/graft

Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting

22325

Treat spine fracture

Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar

22326

Treat neck spine fracture

Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical

22327

Treat thorax spine fracture

Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; thoracic

22328

Treat each add spine fx

Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; each additional fractured vertebra or dislocated segment (list separately in addition to code for primary procedure)

22532

Lat thorax spine fusion

Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic

22533

Lat lumbar spine fusion

Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar

22534

Lat thor/lumb addl seg

Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional vertebral segment (list separately in addition to code for primary procedure)

22548

Neck spine fusion

Arthrodesis, anterior transoral or extraoral technique, clivus-c1-c2 (atlas-axis), with or without excision of odontoid process

22556

Thorax spine fusion

Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic

22558

Lumbar spine fusion

Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar

22586

Prescrl fuse w/ instr l5-s1

Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, l5-s1 interspace

22590

Spine & skull spinal fusion

Arthrodesis, posterior technique, craniocervical (occiput-c2)

22595

Neck spinal fusion

Arthrodesis, posterior technique, atlas-axis (c1-c2)

22600

Neck spine fusion

Arthrodesis, posterior or posterolateral technique, single level; cervical below c2 segment

22610

Thorax spine fusion

Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed)

22630

Lumbar spine fusion

Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar

22632

Spine fusion extra segment

Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each additional interspace (list separately in addition to code for primary procedure)

22800

Post fusion </6 vert seg

Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments

22802

Post fusion 7-12 vert seg

Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments

22804

Post fusion 13/> vert seg

Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments

22808

Ant fusion 2-3 vert seg

Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments

22810

Ant fusion 4-7 vert seg

Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral segments

22812

Ant fusion 8/> vert seg

Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segments

22818

Kyphectomy 1-2 segments

Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); single or 2 segments

22819

Kyphectomy 3 or more

Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); 3 or more segments

22830

Exploration of spinal fusion

Exploration of spinal fusion

22841

Insert spine fixation device

Internal spinal fixation by wiring of spinous processes (list separately in addition to code for primary procedure)

22843

Insert spine fixation device

Posterior segmental instrumentation (for example, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (list separately in addition to code for primary procedure)

22844

Insert spine fixation device

Posterior segmental instrumentation (for example, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (list separately in addition to code for primary procedure)

22846

Insert spine fixation device

Anterior instrumentation; 4 to 7 vertebral segments (list separately in addition to code for primary procedure)

22847

Insert spine fixation device

Anterior instrumentation; 8 or more vertebral segments (list separately in addition to code for primary procedure)

22848

Insert pelv fixation device

Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (list separately in addition to code for primary procedure)

22849

Reinsert spinal fixation

Reinsertion of spinal fixation device

22850

Remove spine fixation device

Removal of posterior nonsegmental instrumentation (for example, harrington rod)

22852

Remove spine fixation device

Removal of posterior segmental instrumentation

22855

Remove spine fixation device

Removal of anterior instrumentation

22857

Lumbar artif diskectomy

Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar

22861

Revise cerv artific disc

Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical

22862

Revise lumbar artif disc

Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar

22864

Remove cerv artif disc

Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical

22865

Remove lumb artif disc

Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar

G0412

Open tx iliac spine uni/bil

Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed

G0414

Pelvic ring fx treat int fix

Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami)

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