Coding & Reimbursement
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SIS is committed to promoting accurate coding and appropriate reimbursement for interventional spine procedures.

MEDICARE & MEDICAID



CODING/REIMBURSEMENT INFO

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CODING QUESTIONS

Perplexed about coding requirements?

Confused about how to code your practice's procedures?

Submit your questions HERE (🔒Members Only)

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SIS INVOLVEMENT IN CODING/REIMBURSEMENT FORUMS
CPT/RUC Process

For many years, the Spine Intervention Society has had an actively participating representative and professional staff at all RUC and CPT meetings. The Society is the only interventional pain organization with consistent participation and volunteers and staff at each meeting.

RUC

The Resource-Based Relative Value Scale (RBRVS) Update Committee (RUC) is an advisory body to the Centers for Medicare and Medicaid Services charged with recommending relative value units (RVUs) that determine the reimbursement level for each CPT code. The RUC assesses the resource costs needed to provide specific services, broken down by physician work, practice expense, and professional liability insurance. Payments are calculated using a conversion factor, determined by CMS.

More information can be obtained HERE.

CPT

The CPT Editorial Panel is in charge of the development and revisions of Current Procedural Terminology procedure codes. More information can be obtained HERE.

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SIS REPRESENTATION

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MEDICARE & MEDICAID

The Centers for Medicare & Medicaid Services (CMS) makes decisions regarding providers and patients on regulatory and reimbursement issues that impact all members of the Spine Intervention Society (SIS). The Health Policy Division actively monitors CMS coding, coverage, and reimbursement policy related to interventional pain management practice. SIS provides feedback to CMS on regulatory and reimbursement issues via comment letters and attendance at meetings.

For additional resources, see:

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SIS COMMENTS TO CMS

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CMS NEWS

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MACRA IMPLEMENTATION NEWS

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CMS EDUCATIONAL OFFERINGS

CMS offers regular educational conference calls for Medicare providers and suppliers about new policies and changes to the Medicare program. To receive notification of upcoming calls, subscribe to the weekly MLN Connects Provider eNews. For more information, see the links below:

MLN ConnectsTM Provider eNews

MLN ConnectsTM National Provider Call Program

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CONTRACTOR LINKS

The Medicare Administrative Contractors (MAC) process claims for Medicare beneficiaries. Contractors are responsible for specific geographic jurisdictions, as listed below. For more information, click HERE


CGS Administrators, LLC
 

  • MAC Jurisdiction DME C-Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Puerto Rico, U.S. Virgin Islands
  • MAC Jurisdiction 15-Kentucky, Ohio

National Government Services, Inc. (NGS) 

  • MAC Jurisdiction DME B - Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin
  • MAC Jurisdiction 6 - Illinois, Minnesota, Wisconsin
  • MAC Jurisdiction K - Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont

Noridian Healthcare Solutions, LLC

  • MAC Jurisdiction DME D-Alaska, Arizona, California, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming, American Samoa, Guam, Northern Mariana Islands
  • MAC Jurisdiction E-California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands
  • MAC Jurisdiction F-Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming

Cahaba Government Benefit Admin

  • MAC Jurisdiction 10-Alabama, Georgia, Tennessee

First Coast Service Options, Inc

  • MAC Jurisdiction N-Florida, Puerto Rico, U.S. Virgin Islands

Novitas Solutions, Inc.

  • MAC Jurisdiction H-Arkansas, Colorado, New Mexico, Oklahoma, Texas, Louisiana, Mississippi
  • MAC Jurisdiction L-Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania (includes Part B for counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia)

Palmetto GBA, LLC

  • MAC Jurisdiction 11-North Carolina, South Carolina, Virginia, West Virginia (excludes Part B for the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia)

Wisconsin Physicians Service Insurance Corporation

  • MAC Jurisdiction 5-Iowa, Kansas, Missouri, Nebraska
  • MAC Jurisdiction 8-Indiana, Michigan

 

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Contact Us

120 E. Ogden Ave. Ste. 202
Hinsdale, Illinois 60521
P: 630.203.2252
Toll Free: 888.255.0005

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