CMS Prior Authorization of Cervical Fusion Procedures Began in July 2021

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CMS Prior Authorization of Cervical Fusion Procedures Began in July 2021

Despite continued efforts by stakeholders to eliminate or delay the implementation of Prior Authorization review in the outpatient prospective payment system (OPPS) settings for cervical fusion and spinal neurostimulator implantation procedures, the review began on July 1, 2021.

With the initiation of the policy, it will 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 CMS and to continue to seek delay or reversal of the policy. ISASS has been involved in a coalition to reverse the policy and participated in a coalition letter in April 2021. The CMS Compliance office responded to the coalition letter in June 2021.

Read the CMS letter from the compliance office here

Read the April 7, 2021, coalition letter here