• Senator Cassidy’s Surprise Billing Legislation

    • A list of questions has been provided for insurance companies and for healthcare providers.
    • An assessment of state-by-state impact in balanced billing (surprise billing) is being performed.
    • Responses are being collated to submit a coordinated response.
    • An essential component of the narrative is that there is currently no incentive for payers to broaden their network. If anything, there is incentive to narrow a network since out-of-network bills will be paid at a rate less than Medicare with the balance left to the patient.

    E/M Services Valued by the RUC

    • The CPT/RUC Workgroup on E/M Coding has submitted a Code Change Application (CCA) to delete 99201 and revise 99202-99215
    • A recommended revision and restructure of E/M Introductory guidelines concerning office and other outpatient codes has been submitted.
    • In addition, a CCA for a Prolonged Services Code has been submitted.
    • The CCAs were presented at the CPT Editorial Panel Meeting on February 7-9, 2019 and passed.
    • A Level of Interest (LOI) form was sent out and is due in April 2019.

    Withdrawal of the CCA CPT Edit for the 63047/22633 from RUC meeting

    • A Commentary on 63047/22633 was published in Neurosurgery. See article here. 
    • Dr. Joseph Cheng prepared a CCA to add clarity to the difference between arthrodesis and decompression. The 22630/33 would have language that details bone removal for access to disc space for interbody fusion but not for decompression.
    • A conference call with stakeholders of AANS/CNS/NASS/AAOS/ISASS could not find consensus.
    • A recommendation was put forth by NASS to use +63048 (an add-on code) to describe additional decompression.
    • A face-to-face meeting to discuss this topic further was suggested.
    • Dr. Cheng’s CCA submission was pulled from the February 2019 CPT/RUC meeting.

    Commercial Payers and 63047-22630/33

    • Aetna, Cigna and Blue Cross Blue Shield have adopted Medicare’s payment policy for these codes.
    • The May CPT Editorial Assistant was not consistent with current coverage determination policies.
    • AANS/CNS has sent letters to all these payers. The response has been mute.

    Bree Collaborative - Lumbar Fusion Final Bundle and Warranty Document

    • Spine Section Rapid Response submitted items of concern.
    • A final vote took place on January 23, 2019 and passed, raising concerns from organized spine surgery.

    WA State HCA HTA HTCC Recommendation Not to Cover SI Joint Fusion

    • Spine Section Rapid Response submitted the evidence to support coverage.
    • Dr. David Polly presented the evidence to support coverage.
    • WA State HCA voted to deny coverage.

    Correction of CPT Assistant July 2018 advice regarding deformity fusion code (22802) with combination code (22633)

    • Dialogue was had with CPT Assistant to offer editorial guidance regarding publication of CPT Assistant articles.

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