CMS Asked to Consider Assigning Payment in Office Facility Settings for SI Joint Fusion Procedures

As part of the 2024 Medicare Physician Fee Schedule, CMS stated they are soliciting feedback on assigning practice expense relative value units (RVUs) in the office setting for sacroiliac (SI) joint fusion, CPT code 27279: “Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device.” In the rule, CMS stated they are concerned about potential safety risks for patients if this procedure is performed in the office setting. ISASS agrees with this concern and plans to submit comments agreeing with CMS and opposing non-facility (office-based) setting payment for 27279.

In addition, CMS is proposing to allow office-based dorsally placed bone allograft within the sacroiliac joint (“dorsal allograft” procedures, CPT 2X000). The total RVU to a physician performing this procedure in the office is proposed at 364.74, which would make it among the highest paid procedures in the entire Medicare Physician Fee Schedule.

ISASS will submit comments relating to the significant safety concerns affecting patients if these proposals for CPT 2X000 were to become final. The dorsal allograft SI joint procedure is more invasive than other spine procedures, which Medicare currently does not allow to be performed in office settings. Some concerning observations made by ISASS about allowing this type of spine surgery to be payable by Medicare in office settings include:

1. 2X000 is still undergoing clinical study (PainTEQ SECURE trial is underway). The SECURE study had 1 patient death, and no study procedures were performed in an ASC, let alone an office setting. Only the hospital site of service was discussed.
2. The safety profile of 2X000 is more akin to ASC-based procedures like mild and Vertiflex. It is not a needle-based procedure like kyphoplasty.
3. CMS should be concerned with, and anticipate, overutilization if 2X000 is allowed in the office. There is evidence of office-based vascular procedures (e.g., atherectomies) doubling and even tripling in Medicare procedure volumes and payments to physicians over the past 5-10 years.
4. Potentially, 2X000would be among the highest-paying codes in the MPFS if CMS accepts the RUC recommendations.

We encourage individual members and practices to submit comments on this proposed rule at: https://www.regulations.gov/document/CMS-2023-0121-1282