Action Alert!

Attention ISASS Members within WPS Medicare Jurisdiction: Michigan, Indiana, Iowa, Nebraska, Missouri and Kansas

WPS Medicare – Proposed non-coverage decision – DL35994 – Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain

On April 1, 2015, Wisconsin Physicians Service Insurance Corporation (WPS Medicare) issued a proposed non-coverage determination for minimally invasive sacroiliac joint fusion (MIS SIJ fusion). According to its draft Local Coverage Determination (LCD), WPS Medicare believes that the SI joint is a controversial source of primary low back pain and cannot be effectively isolated as a pain source. Additionally, WPS Medicare states that fusion/stabilization of the SI joint for the treatment of back pain presumed to originate from the SI joint is considered investigational and surgery is rarely performed for SI joint dysfunction. It is clear that WPS Medicare did not conduct a comprehensive review of the data and literature on MIS SIJ fusion prior to issuing its draft non-coverage determination as evidenced by the five sources it cites in its draft LCD. An open public meeting was held on May 7, 2015. Two individuals (Dr. Carlton Reckling from SI Bone and Dr. Craig Meyer, an orthopedic surgeon practicing in Columbia, Missouri) made presentations in opposition to the proposed non-coverage determination. WPS Medicare is now accepting public comments on its proposal until June 27, 2015.

Based on physician outreach and research conducted over the past several years on MIS SIJ fusion, ISASS drafted and submitted comments on June 17, 2015 in opposition to the proposed non-coverage decision and urged WPS Medicare to issue a positive coverage determination and include the recommended coverage criteria developed by ISASS into its coverage policy. ISASS provided WPS Medicare with 51 articles of importance and requested WPS Medicare review the articles along with the ISASS policy statement on MIS SIJ fusion prior to issuing a final coverage determination.

It is critical that WPS Medicare hear directly from individual surgeons on this matter. To voice your concerns on the draft non-coverage determination and submit comments directly to WPS Medicare, please see the information below. Your comments should include information such as the number of MIS SIJ fusion surgeries you have performed, Medicare patient outcomes, benefits of the procedure to Medicare patients and why it is important to protect the physician-patient decision-making process. The comment period closes on June 27, 2015.

Address comments to:
Olatokunbo Awodele, M.D., MPH
WPS Medicare
3333 Farnam Street
Omaha, NE 68131

Email comments to:
policycomments@wpsic.com

WPS Proposed Non-Coverage Determination: http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35993&ContrId=268