NASS notched a significant victory for spine care providers and patients in preserving access to medically necessary procedures in the Medicare Physician Fee Schedule Final Rule for calendar year 2023, which was released late yesterday and will be implemented January 1, 2023. Due to NASS’ comprehensive and persuasive comments as well as meeting with the Centers for Medicare and Medicaid Services (CMS) after the proposed rule was released, CMS changed their position on proposed payment cuts for most of the codes and accepted the values recommended by NASS, the AMA Relative Value Update Committee (RUC), and other societies.
In this rule there are several spine-specific issues related to arthrodesis and decompression codes that would have significantly reduced payment for these procedures had the proposed values been finalized. While CMS changed its valuation for codes 22630, 22633 and 22634, as shown below, it finalized values for codes 63052 and 63053 less than those recommended by specialty societies and the RUC. NASS will continue working to address this issue with CMS and the RUC.
Brief History of Arthrodesis/Decompression Code Issue
In 2021, another society proposed the creation of decompression codes (63052/63053) to be used with PLIF/TLIF procedures. Due to NASS’ experience in coding and reimbursement, we had the foresight to understand the implications of new code development, and recommended using existing code 63048 for cases when additional decompression, other than for placement of the interbody device, needs to be performed. The CPT Editorial Panel opted to pursue the new code recommendations made by the other society, and those codes became effective in 2022.
Once the new decompression codes were created, the RUC and CMS predictably requested to revalue the arthrodesis codes. When new codes are created, the value for those codes needs to be taken from existing codes – and existing codes often lose value. When the revaluation took place in 2002, the RUC made their recommendations based on member surveys from NASS and several other spine societies.
What the Final Rule Means for You
The proposed rule has now been finalized. While NASS is pleased that CMS addressed many of our concerns, overall Medicare payments for all physicians will decline in 2023 due to a 4.47% reduction in the Medicare conversion factor due to a statutorily required budget neutrality adjustment as well as a required expiration of the 2022 conversion factor increase.
We are not done. Our advocacy organization, the National Association of Spine Specialists, is working to make sure our members receive fair reimbursement through lobbying of Members of Congress as well as directly connecting NASS members to their elected officials via a grassroots email campaign. As of now, NASS members have already contacted over 35 percent all members in the U.S. House and Senate. Visit SpineAdvocacy.org
for more information about how you can help NASS fight for you.