On November 2, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies, payment rates and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. The PFS pays for services furnished by surgeons, physicians, and other practitioners in all...

On November 1, HCSC (BCBS Illinois, BCBS Montana, BCBS New Mexico, BCBS Oklahoma, BCBS Texas) posted a draft updated lumbar fusion medical policy for comment through November 16. The draft policy establishes conditions for which lumbar spinal fusion may be considered medically necessary by HCSC. ISASS submitted comments specific to HCSC’s designation of lumbar fusion to...

ISASS Recommendations/Coverage Criteria for Decompression with Interlaminar Stabilization – Coverage Indications, Limitations, and/or Medical Necessity Authors: Richard Guyer, MD; Michael Musacchio, MD; Frank P. Cammisa, Jr., MD; and Morgan P. Lorio, MD, FACS   This paper was originally published here. A PDF version of this Policy Statement can be accessed here.   Introduction B...

On November 3, ISASS submitted comments to Novitas Solutions Inc., the Medicare Administrative Contractor (MAC) covering Colorado, New Mexico, Oklahoma, Texas, Arkansas, Louisiana, Mississippi, Delaware, D.C., Maryland, New Jersey, and Pennsylvania, on its draft Local Coverage Determination (LCD) on Percutaneous Vertebroplasty and Vertebral Augmentation (Kyphoplasty). The comment letter focused...