On July 29, CMS published the proposed Physician Fee Schedule Rule for 2020.

In the proposed rule, the Centers for Medicare and Medicaid Services (CMS) has proposed several changes that will affect ISASS members:

• With the budget neutrality adjustment to account for relative value changes, as required by law, the proposed 2020 PFS conversion factor is $36.09, a slight increase above the 2018 PFS conversion factor of $36.05.
• CMS proposed payments for new structural allograft codes used in orthopaedic trauma and oncology services (new CPT codes, 209X3, Osteoarticular Allograft, 209X4, Hemicortical Intercannulary Allograft, and 209X5, Interarticular Intercannulary Allograft Complex)
• CMS proposed updated payments for plain film X-ray codes for spine (CPT codes 72020-72220)
• CMS proposed updated payments for Patient Office and Outpatient visits, with proposed increases for Level 3, 4, and 5 New and Established Patient encounters as well as proposing reduced medical record documentation requirements.

If finalized, these changes will go into effect for the 2020 Medicare Physician Fee Schedule.

CMS is also requesting comments on potential elimination of the 10-day global period, which would reduce the reimbursement values for codes with 10-day globals such as Kyphoplasty and Vertebroplasty. CMS is not proposing elimination of the 10-day global period for calendar year 2019, but potentially considering the action for future years.

ISASS is currently reviewing the rule and will be commenting to CMS on the above issues and more to promote appropriate reimbursement for interventional spine procedures.

To read the CMS fact sheet, click here.

To read the Proposed Rule, click here.