Spine Surgery Procedure RVUs Reviewed as Part of the Medicare Physician Fee Schedule 2022 Final Rule

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Spine Surgery Procedure RVUs Reviewed as Part of the Medicare Physician Fee Schedule 2022 Final Rule

As part of the 2022 Medicare Physician Fee Schedule proposed rule, several sets of spinal surgical procedures were included as either new to the Physician Fee Schedule or existing services that were reviewed or revalued.

Specifically, CMS reviewed new codes for arthrodesis decompression when performed with fusion, new codes for basivertebral nerve ablation (Intracept procedure), and a revised value for insertion of spinal stabilization devices (Coflex).

CMS proposed updating the Relative Value Units (RVUs) assigned to Current Procedural Terminology (CPT) 22867, “Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level” (Coflex). The current work RVU for 22867 is 13.50, and CMS proposed an increase to 15.00. The total RVUs for 22867 under the proposed rule would be 32.11, a change from the current total RVUs of 28.28. This update was led by ISASS and initiated with a request to CMS to review the service under its Misvalued Code initiative. ISASS then worked with other spine surgery societies to advocate for the updated values through the American Medical Association RVS Update Committee (RUC).

CMS is proposing new RVUs for additional decompression when performed with posterior or transforaminal lumbar interbody fusion (PLIF or TLIF). New CPT codes 63052 and 63053 describe decompression when done with PLIF or TLIF procedures (22630/32 and 22634/36). 63052 describes the first level decompression and 63053 describes additional levels of decompression. CMS finalized work RVUs of 4.25 for 63052, a change from the proposed rule work RVU of 3.08, and 3.19 for 63053, a change from the proposed rule work RVU of 2.31.  These updated RVUs were the result of ISASS comments and meetings with CMS that occurred subsequent to the publication of the proposed rule in July.

CMS is also proposing new RVUs for basivertebral nerve ablation. Two new CPT codes, 64628 and 64629, describe ablation of the basivertebral nerve first level and each additional nerve, respectively.

ISASS will review the final rule in detail and provide written comments to CMS to all relevant issues in advance of the comment deadline. ISASS also encourages individual members to write their own comments to CMS in response to the proposed rule describing the potential impacts on their practices when procedures get undervalued by CMS relative to the resources needed to safely and effectively perform the procedures. ISASS is also closely coordinating responses with other stakeholders and will look to conduct in-person meetings with agency officials to advocate for appropriate payment for these services.

CPT Code Descriptor Current Work RVU RUC Proposed Work RVU CMS

Work RVU

22867 Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression; lumbar; single level 13.50 15.00 15.00
63052 Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]) during posterior interbody arthrodesis; lumbar; single vertebral segment N/A (new code) 5.55 4.25
63053 Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina, and/or nerve root[s] [eg, spinal or lateral recess stenosis]) during posterior interbody arthrodesis; lumbar; each additional segment N/A (new code) 4.44 3.19
64628 Thermal destruction of intraosseous basivertebral nerve, inclusive of all imaging guidance; first two vertebral bodies; lumbar or sacral N/A (new code) 8.25 7.15
64629 Thermal destruction of intraosseous basivertebral nerve, inclusive of all imaging guidance; each additional vertebral body; lumbar or sacral N/A (new code) 4.25 3.77