ISASS and Other Spine Surgery Groups Meet with CMS to Discuss Several Spine Surgery Procedure RVUs Reviewed As Part of the Medicare Physician Fee Schedule 2023 Proposed Rule
On August 25, 2022, ISASS Coding and Reimbursement Chair, and ISASS RUC Advisor, Morgan Lorio, MD met as part of a coalition of societies with leaders of the Centers for Medicare and Medicaid Services (CMS) to discuss several sets of spinal surgical procedures were included as either new to the Physician Fee Schedule or existing services that were reviewed or revalued.
Other societies involved in the meeting were the American Academy of Orthopaedic Surgeons (AAOS), the North American Spine Society (NASS), the American Association of Neurological Surgeons (AANS), and the Congress of Neurological Surgeons (CNS).
Specifically, Dr. Lorio and the other leaders discussed the CMS proposed RVUs for Arthrodesis Decompression when performed with Fusion, Fusion with Minimal Decompression to Prepare the Interspace, and Lumbar Laminotomy codes.
The table below shows the CMS proposed work RVUS compared to the recommendations made to CMS by the AMA/Multi-Specialty Society Relative Value Update Committee (RUC).
CPT CODE CPT Descriptor Current 2022 Work RVU Proposed RUC 20230 Work RVU Proposed CMS 2023 Work RVU 22630 TLIF w/minimal decompression first level 22.09 22.09 20.42 22632 TLIF w/minimal decompression additional level 5.22 5.22 5.22 22633 PLIF w/minimal decompression first level 27.75 26.80 24.83 22634 PLIF w/minimal decompression additional level 8.16 7.96 7.30 63052 Lumbar decompression w/arthrodesis first level N/A (new code) 5.70 4.25 63053 Lumbar decompression w/arthrodesis first level N/A (new code) 3.78 5.00 63020 Laminotomy Cervical first level 16.20 15.96 14.91 63030 Laminotomy Lumbar first level 13.18 13.18 12.00 63035 Laminotomy Cervical or Lumbar additional level 3.15 4.00 3.86
The RUC recommendations reflect the recommendations made by ISASS and other spine surgery societies to the RUC and are based on surveys of members who perform the procedures. ISASS is extremely disappointed with the CMS proposed values and are meeting in August with the Agency to discuss the proposed values and argue for accepting the RUC recommended values. In addition, ISASS will be submitting extensive written comments to the agency on the proposed values.
In addition to the meeting, ISASS will review the proposed rule in detail and provide written comments to CMS to all relevant issues in advance of the comment deadline.
CMS will publish the final rule in early November 2022.