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SIS and NASS Recommend Spine Intervention Coverage Policy Revisions to Claims Processor CGS (January 25, 2017)

On January 24, 2017, the Spine Intervention Society (SIS) and the North American Spine Society (NASS) jointly notified U.S. Medicare administrative contractor CGS Administrators, LLC (CGS) that its Local Coverage Determination (LCD) on Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy (L34832; 15101 – MAC A, 15102 – MAC B, 15201 – MAC A, 15202 – MAC B) contains extensive errors, omissions, and inconsistencies.
SIS and NASS are committed to assuring that appropriate, effective, and responsible treatments are preserved to improve patient access to care and outcomes and have offered to assist CGS in establishing a reasonable coverage policy that will eliminate inappropriate utilization while preserving access in appropriately selected patients.
SIS advocates on behalf of spine care physician members across 42 countries and NASS represents nearly 9,000 spine care providers from several disciplines. Together SIS and NASS represent practitioners across the 38 U.S. states where CGS services Medicare beneficiaries, healthcare providers, and medical equipment suppliers.
Read the joint statement for specifics on the LCD.

International Spine Intervention Society Members Succeed in Convincing Premera to Adopt Appropriate Coverage (June 18, 2014)

Drs. Paul Dreyfuss and Ray Baker met with the medical director of the Premera Blue Cross insurance plan to discuss Premera's decision to not cover C 2-3 facet radiofrequency neurotomy. As a result of the meeting, Premera issued a new policy providing coverage for C 2-3 facet RF neurotomy.


BCBS of Tennessee Drops Plan for Non-Coverage of Cervical Epidurals (December 18, 2013)

In last month's e-news we shared with you that the International Spine Intervention Society submitted comments and summary of evidence to Blue Cross Blue Shield of Tennessee regarding their draft policy, which stated that epidural steroid injections for the treatment of pain are considered investigational. We are pleased to have learned that BCBS of TN has decided not to finalize their draft policy and these procedures, invaluable to many of our patients, will remain covered. To read the letter submitted by the Society.


Tennessee Medicaid Reverses Non-Coverage Policy for Facet Interventions (November 22, 2013)

An International Spine Intervention Society member and instructor from Tennessee - Dr. Graf Hilgenhurst - led a successful effort to reverse a non-coverage policy for facet joint interventions issued by Tennessee Medicaid Plan (TennCare). TennCare planned to implement a policy denying facet interventions starting on October 1, 2013. Dr. Hilgenhurst obtained assistance and strategic advice from the Society and, on September 17th, 2013, he and other Tennessee interventional pain physicians met with Dr. Vaughn Frigon, Chief Medical Officer for TennCare, to discuss the issue. As a result of the meeting, TennCare altered the planned policy to cover diagnostic medial branch blocks and medial branch radiofrequency neurotomy. Congratulations to Dr. Hilgenhurst and all who were involved.


SIS Addresses Amerigroup Policy on Headache and Occipital Neuralgia Coverage (March 24, 2017)

The Spine Intervention Society (SIS) issued comments to Amerigroup Corp. on March 22, 2017 about the payer’s coverage exclusions of third occipital nerve (C2-3) denervation and radiofrequency neurotomy (RF) treatments for headache and occipital neuralgia. SIS recommends access to these procedures for Amerigroup’s millions of U.S. members.

Read the SIS comment letter for a summary of evidence from the literature and an explanation for the recommendation.


SIS’s Expertise Sought to Clarify Technical Aspects of Cooled Radiofrequency Neurotomy (March 23, 2017)

In February 2017, the Spine Intervention Society (SIS) was asked by Halyard Health to address confusion within the payer community about the tissue temperatures achieved by cooled radiofrequency neurotomy. Halyard believes that cooled radiofrequency neurotomy and cryoablation are being conflated by payers, which may be limiting access to these treatments.

On March 20, 2017, SIS issued a comment letter to Halyard citing the evidence in support of cooled radiofrequency neurotomy’s effectiveness and capability of generating lesions by achieving tissue temperatures at or above 80° C. SIS urges payers to correctly classify the procedure as thermal radiofrequency neurotomy. Read the comment letter for further details.


SIS Comments on Coverage Exclusions in Humana’s Headache and Occipital Neuralgia Treatment Policy (March 22, 2017)

On March 17, 2017, the Spine Intervention Society (SIS) informed Humana that exclusions in the Humana coverage policy, “Headache and Occipital Neuralgia Treatments,” (policy number HGO-0455-012, issued 02/23/2017), are inconsistent with the evidence-base.

Humana now excludes coverage for third occipital nerve (C2-3) denervation and radiofrequency neurotomy (RF) for its members; incorrectly considering these beneficial treatments to be experimental/investigational.

SIS’s comment letter summarizes the available literature, citing 16 peer-reviewed medical articles that counter Humana’s policy, and offers Humana ongoing input and expertise in this matter.

 Read the SIS comment letter and view the Humana policy.


SIS Sends Comments to Blue Shield of CA and CIGNA (December 9, 2015)

On November 30, SIS sent a comment letter to BlueShield of CA regarding their Facet Joint Denervation, Policy 7.01.116 which specifically excludes third occipital nerve (C2-3) denervation or radiofrequency neurotomy (RF), suggesting that there is insufficient evidence to support its use. The letter requests coverage for the procedure, citing the key literature in support of it.

On December 2, SIS sent a letter to Cigna to comment on their Precertification Program and Coverage Policies, offering comments and suggestions targeted at improving the policies to ensure that procedures are accessible to appropriately-selected patients.

SIS Addresses BlueCross BlueShield of North Carolina on Coverage Policy on Facet Joint Denervation

The Spine Intervention Society (SIS) Health Policy Division's Coverage Committee recently reviewed the current BCBS NC coverage policy on facet denervation. A letter from the President of SIS, Dr. John MacVicar, was submitted to BCBS NC on November 11, 2015 regarding suggestions to improve the coverage policy to ensure appropriate access to cervical radiofrequency neurotomy.


SIS Submits Comments on Novitas LCD on Facet Joint Injections

On November 3, 2015, SIS submitted comments on the Novitas draft LCD #DL34974 Facet Joint Injections. The comment letter noted several inconsistencies within the LCD and provided two recommendations for revision.


SIS Submits Comments on UHC Occipital Neuralgia and Headache Treatment

On October 5, SIS submitted comments to UnitedHealthcare regarding their Occipital Neuralgia and Headache Treatment, Policy Number: 201570080O.


SIS Coordinates Submission of Comment Letter to the Washington State Health Care Authority (September 16, 2015)

SIS coordinated the drafting and submission of a letter joined by multiple other organizations to the Washington State Health Care Authority’s (WA HCA) Health Technology Assessment Program. Earlier this month, the WA HCA initiated a comment period for review of the draft key questions that will frame their upcoming re-review of spinal injections. This review of spinal injections is premature, and according to WA HCA, was prompted by new evidence (i.e. Friedly’s LESS study) and new safety concerns (i.e. the FDA’s labeling changes for epidural injection of steroid). Their proposed inclusion/exclusion criteria stipulate exclusion of non-RCT evidence (unless related to safety), and their proposed questions fail to require subgroup analyses by diagnosis, use of image guidance, or approach/access to ensure homogeneity of patient populations. With questions and inclusion/exclusion criteria as proposed, the resulting report will do a tremendous disservice to spinal injections, mirroring the recent AHRQ technology assessment. The difference: WA HCA is performing the review expressly to inform coverage determinations.


Comments Submitted to Washington HTA Regarding Draft Evidence Report

On January 27, 2014 the International Spine Intervention Society submitted extensive comments to the Washington State Health Technology Clinical Committee regarding a very flawed draft evidence report. The letter was prepared with an extensive amount of work by the Standards Division members.


International Spine Intervention Society Helps Improve New CO Workers' Compensation Back and Neck Pain Treatment Guidelines (February 25, 2014)

The new Colorado Workers' Compensation Low Back Pain and Cervical Injury Treatment Guidelines were posted earlier this week. Colorado physicians and Society representatives spent numerous hours advocating for the best possible care for Colorado's Workers Compensation Patients. The original draft of these guidelines was very restrictive with respect to patient access to spine intervention care. They were based on a very narrow interpretation of the available evidence with an overemphasis on cost savings. For more information, please visit this link


International Spine Intervention Society Submits Comments to BCBS of Tennessee on Non-Coverage of Cervical Epidural Steroid Injections (November 22, 2013)

On November 7, 2013 the International Spine Intervention Society submitted a comment letter to Blue Cross Blue Shield of Tennessee opposing their draft policy, which states that epidural steroid injections for the treatment of pain are considered investigational. The Society strongly disagrees with this assessment and submitted a summary of evidence, an excerpt of a consensus document endorsed by 11 societies, as well as an invitation for BCBS to work together on developing a reasonable policy. Read the letter letter submitted by the Society.


International Spine Intervention Society Provides Comments on Colorado Workers' Compensation Guidelines (February 22, 2013)

The International Spine Intervention Society Health Policy and Standards Divisions reviewed and prepared extensive remarks on significant changes to the State of Colorado Workers Compensation Guidelines on cervical and low back pain. The Colorado Workers' Compensation Division held a hearing on the guidelines on November 19, 2013, where a number of Society members testified. Review the Society's letter letter submitted to the Colorado Workers Compensation.


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