CMS Responds to Request for Delay of Prior Authorization of Cervical Fusion Procedures

In a letter dated June 3, 2021, CMS’ Director of Provider Compliance, Connie Leonard responded to an April 7, 2021, letter from a coalition of healthcare stakeholders, including ISASS, asking CMS to delay implementation of prior authorization in the ambulatory surgical center (ASC) and outpatient prospective payment system (OPPS) settings for cervical fusion and spinal neurostimulator implantation procedures, which are scheduled to begin on July 1, 2021.

CMS informed the coalition they would not further delay implementation of the prior authorization beyond July 1, stating in their letter that they believe Medicare Administrator Contractors (MACs) are properly equipped to carry out the prior authorization reviews.

Ms. Leonard’s letter also did not offer to provide greater transparency and sharing of information on the impacts of the prior authorization review as the coalition letter proposed.

Without action to delay implementation, it will also be important to track and share information related to the addition of cervical fusion with disc removal and implanted spinal neurostimulators to the nationwide prior authorization process for hospital outpatient department services. This tracking will be vital for appropriate oversight to ensure beneficiary access is maintained and an efficient process is established for both providers and beneficiaries. ISASS will work to provide input to the coalition seeking delay or reversal of the policy, particularly in the upcoming 2022 Medicare Proposed Rule for the OPPS/ASCs, which will be published in July or August 2022.

Read the CME letter from Director Leonard here

Read the April 7, 2021, coalition letter here