Becker's Spine Review

14 Sign up for Becker's Orthopedic, Spine Business & Pain Management E-Weeklies at www.BeckersOrthopedicandSpine.com or call (800) 417-2035 H ere are 10 recent spine surgery and in- terventional back pain procedures with coverage updates. 1. Aetna revised coverage on medical necessity for spinal cages to include coverage for "medically necessary" cervical spinal fusion for members that meet specific criteria. Last year, the insurer considered changing its medical necessity policy for spinal cages to include use with autogenous bone graft patients meeting the criteria for spinal fusion and thoracic fusion, but excluding cervi- cal fusion; however the revised policy released in 2014 includes limited criteria for cervical cases. 2. The National Coverage Analysis for percutane- ous image-guided lumbar decompression issued a decision not to cover the procedure for patients with spinal stenosis. CMS will not cover the proce- dure and the American Association of Neurologi- cal Surgeons and Congress of Neurological Sur- geons support this decision, as the literature has not proven patients receive better outcomes from PILD, according to a letter from the organizations. 3. Despite the lack of coverage for PILD procedures, patients enrolled in the approved CED clinical study for VertiFlex's Totalis Direct Decompression System will be able to receive Medicare coverage for the procedure. CMS has decided to extend cov- erage to patients in the investigational trial. 4. The American Medical Association's CPT Edi- torial Panel voted to establish a Category I CPT Code for minimally invasive sacroiliac joint fu- sion earlier this year. The current Category III CPT code will be deleted. These changes will go into effect Jan. 1, 2015. 5. The 2014 CMS Final Physician Fee Schedule Rule revised upward the Practice Expense Relative Value Unites for CPT Code 22586 for pre-sacral in- terbody fusion to increase the RVUs for the code by 18 percent over the 2013 RVUs. The procedure, which can be performed with Baxano Surgical's AxiaLIF Plus implant, is now 53.76 RVUs. 6. Health Care Services Corporation announced in February 2014 it will reimburse for MiMedx's EpiFix allograft, a device with use in wound care, soft tissue replacement and surgical treatment in the spine and knees. There are currently 12 state Medicaid programs that also reimburse for EpiFix. 7. The 2014 CMS Final Physician Fee Schedule Rule significantly reduced reimbursements for several in- terventional pain procedures, including cuts for cer- vical and lumbar epidurals. Physicians now receive $42 payment for performing these procedures. 8. The 2014 CMS Final Physician Fee Schedule Rule included payment rate decreases for physi- cians performing spinal cord stimulation in-of- fice trials. However, facilities supporting proce- dures received an increase. Beginning Jan. 1, 2014, physicians were required to bill CPT 63650 for each lead implanted, which has been revalued to include the cost of trial leads. Additionally, CMS will pay the highest value CPT code at 100 percent and each additional CPT code at 50 percent, ac- cording to a report from St. Jude Medical. 9. In December of 2013, the Blue Cross Blue Shield of Tennessee dropped its plan for non-coverage of cervical epidurals. Their draft policy state epidural steroid injections for treating pain were considered investigational, but BCBS of TN decided not to fi- nalize the policy and cervical epidurals will remain covered, according to a report from the Interna- tional Spine Intervention Society. 10. The American Medical Association CPT Edi- torial Panel gave two-level cervical disc arthro- plasty a Category I CPT code and revised the ex- isting Category III CPT code to describe three or more level arthroplasty. The change will go into effect Jan. 1, 2015. n 10 Spine Reimbursement updates By Laura Miller YOU CANNOT AFFORD TO LOSE MORE REVENUE! www.smpsd.com | 605.444.8207 | info@smpsd.com Providing Custom Solutions Experts in Customized Revenue Optimization Billing | Coding Coding Reviews Managed Care Contracting Revenue Cycle Audits Fee Schedule Analysis Call the Expert in Revenue Optimization

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