On November 2, 2017, 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, 2018. The PFS pays for services furnished by physicians and other practitioners in all sites of service. These services include but are not limited to visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. As part of the final rule, CMS issues final values for new codes and codes deemed misvalued. Please see the spine code spreadsheet for a comprehensive comparison of RVUs and reimbursements of spine procedures from the 2017 final rule to the 2018 final rule. Some highlights of the final rule include:
- CMS finalized the RUC-recommended value (1.16 work RVUs) for a new Category I code to report bone marrow aspiration for bone grafting in spine surgery (CPT Code 20939 – Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision).
- CMS flagged CPT code 27279 (minimally invasive sacroiliac joint fusion) as potentially misvalued after consideration of data gathered by ISASS in the form of two paired comparison surveys on the work involved in the procedure. CMS asked the Relative Value Scale Update Committee (RUC) to re-evaluate the code. ISASS will participate in the RUC process in the coming months.
- CMS is delaying implementation of the Appropriate Use Criteria for Diagnostic Imaging Services to January 1, 2020.
- CMS finalized five new modifiers for reporting patient relationship categories. Voluntary reporting of the modifiers starts January 1, 2018. CMS anticipates enforcing mandatory reporting of patient relationship categories at a later date, after physicians gain familiarity with the categories and modifiers.