Coverage

SIS actively advocates for appropriate access to interventional spine procedures.

IN THE SPOTLIGHT: ACCESS AT RISK
Agency for Healthcare Research and Quality (AHRQ)
Oregon Health Authority
Washington Health Care Authority

COMMENT LETTERS
Epidural Injections
Facet Interventions
Sacroiliac Interventions
Neurostimulation
Other Interventions

COVERAGE POLICY RECOMMENDATIONS (đź”’Members Only)


IN THE SPOTLIGHT: ACCESS AT RISK

Agency for Healthcare Research and Quality (AHRQ)

Medical Societies Collaborate and Respond to AHRQ Technology Assessment (July 30, 2015)

On July 29, 2015, the Spine Intervention Society joined 13 other medical specialty societies in sending a letter to Elise Berliner, PhD, Director of AHRQ’s Technology Assessment Program. The letter addresses concerns regarding the recently published AHRQ technology assessment Pain Management Injection Therapies for Low Back Pain. The letter requests that due consideration be given to these concerns, and that several aspects of the report be revisited to ensure that the best available evidence is addressed scientifically in order to provide an accurate assessment of the procedures reviewed. The letter is available here and will be submitted for publication shortly.

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AHRQ Publishes Methodologically Flawed Technology Assessment on Pain Management Injection Therapies (April 15, 2015)

Despite the best efforts of the Spine Intervention Society to provide extensive comments, suggestions, and references in response to the Agency for Healthcare Research and Quality's (AHRQ) draft Technology Assessment on Pain Management Injection Therapies for Low Back Pain, the report has been published without rectifying significant flaws in the report's methodology, interpretation of study results, and conclusions.  

Spine Intervention Society leadership is disturbed by the authors' dismissive responses to robust, critical comments aimed at obtaining an accurate assessment of the state of the evidence.  We encourage our members to review the report, which will likely be used by Medicare and private payers to inform decisions relative to coverage decisions for injection procedures -- many of which, contrary to the report's conclusions, are very effective tools in the treatment of appropriately-selected patients.  

The report can be viewed here.

The comments submitted by the Spine Intervention Society during public comment period can be viewed here.

The comments submitted by Dr. Timothy Maus, an invited peer reviewer, can be viewed here.

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Oregon Health Authority

Take Action Now! Help Your Patients Regain Access to Interventional Spine Procedures (April 21, 2017)

Patients on Medicaid, in the state of Oregon, no longer have access to ANY interventional spine procedures for back pain. Most patients no longer even have access to surgery and none have the option of palliative care with long-term opioid treatment. What treatments are these patients left with? The Oregon Health Authority (OHA) now recommends acupuncture, manipulation, massage, medications (excluding long-term opioid treatment), cognitive behavioral therapy, physical therapy/occupational therapy, and even yoga as the only viable treatments for back pain.

SIS and the 13 other member associations of the Multi-Society Pain Workgroup (MPW) are continuing to develop a coordinated a response to this critical oversight, but now is the time for you to act!

What you can do:

  • Contact your local newspaper and news stations and make your community aware of this important issue.
  •  Let OHA know what you think. On social media mention OHA and use the hashtag #saveinjections.
  • Find your congressional representatives’ contact information, and demand action.
  •  Take colleagues and patients to the next Oregon Health Authority committee meetings and provide testimony about the effectiveness of interventional spine procedures.  Invite your congressional representative and the media to attend.
  • Upcoming Meetings:

 May 18th:  Corticosteroid Injections
Value-based Benefits Subcommittee and Health Evidence Research Commission will review proposed coverage guidance recommending AGAINST corticosteroid injections.

June 1st: Percutaneous Interventions (Radiofrequency Neurotomy)
Evidence-based Guidelines Subcommittee will review proposed coverage guidance recommending AGAINST coverage for radiofrequency neurotomy.

Make your voice heard and be your patients’ advocate. But don't stop there. Encourage your patients to do the same. Without reasoned protest from all those affected, many of your patients will continue to be left without effective treatment options and relegated to lives plagued by chronic pain and disability.

Share your concerns and stories. Follow these suggestions for talking points for you and your patients to use in your efforts to convey the importance of regaining access to interventional spine procedures:

PHYSICIANS/HEALTH CARE PROVIDERS

1. Interventional spine procedures (injections/RFN) are critical tools in my toolbox.

  • Spine injections have helped hundreds/thousands of my patients regain quality of life.
  •  These procedures are safe and effective and can help appropriately selected patients.
  • Share a specific patient success story.

2. Without these treatments, what are my patients left with?

  • Interventional spine procedures are indicated when conservative treatments have failed.
  • When we have procedures that can help, how can I tell my patients, experiencing terrible pain and unable to do the most basic things, that all I can offer is an Advil and yoga?
  • What will happen to my patients who don’t have access to interventional spine procedures that will help them improve their pain and function?

3. Oregon Health Authority’s public comment policy precludes submission of comprehensive comments and adequate consideration of the evidence of effectiveness of procedures.

  • Word limit restriction on written comments: 1000 words
  • Public comment/testimony at meetings – comment may be limited to five minutes per topic (shared among all those who wish to testify)
  • How can we convey the value of these procedures with such restrictions on public comment?

PATIENTS

1. Share your own story or that of a friend/family member. 

2. How will your life/has your life been affected if these procedures are no longer available?

3. Oregon Health Authority’s public comment policy precludes submission of comprehensive comments and adequate consideration of the evidence of effectiveness of procedures.

  • Word limit restriction on written comments: 1000 words
  • Public comment/testimony at meetings – comment may be limited to five minutes per topic (shared among all those who wish to testify)
  • How can we convey the value of these procedures with such restrictions on public comment?

Please contact SIS if you need additional assistance or to share information about your advocacy efforts.

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OHA Recommends Against ESIs; Considers Draft Guidance on Percutaneous Interventions (April 18, 2017)

The Oregon Health Authority’s (OHA) Evidence-based Guidelines Subcommittee (EbGS) met April 6 and referred the draft coverage guidance on Low Back Pain: Corticosteroid Injections to the Value-based Benefits Subcommittee (VbBS) and Health Evidence Review Commission (HERC) for review at their meetings May 18, 2017.  Despite multiple comments submitted by SIS, the Multisociety Pain Workgroup (MPW), and others, as well as presentations made by local physicians and patients in attendance, the Coverage Guidance was approved as presented and recommends against coverage for corticosteroid injections.

The EbGS also heard public testimony from physicians on April 6 regarding the draft coverage guidance on Low Back Pain: Minimally Invasive and Non-Corticosteroid Percutaneous Interventions. Dr. David Sibell, SIS Instructor and Education Division member, made comments focusing on the importance of appropriate patient selection and implementation of meticulous technique for radiofrequency neurotomy, as described in the SIS Guidelines. His comments were well-received and have prompted an OHA invitation to compile materials for OHA’s EbGS consideration in preparation for discussion on this topic on June 1, 2017.  SIS will work with Dr. Sibell to prepare materials for EbGS review.  We will also review and prepare comments for MPW sign-on consideration regarding the draft coverage guidance. 

A special note of gratitude to those who attended the meetings and made presentations: Dr. David Sibell; Dr. Kim Mauer, Comprehensive Pain Center’s Medical Director; and Dr. Sandy Christiansen, who read a statement prepared by Dr. Steven Cohen. Thanks to all the other local physicians and patients for their tireless commitment and invaluable efforts to regain coverage for interventional spine procedures.

SIS remains committed to preserving patient access to safe and effective procedures, and we will continue to advocate for patients and physicians in Oregon State.

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On April 6, 2017 Do Your Part to Restore Coverage for Interventional Spine Procedures in Oregon (March 9, 2017)

 On April 6, 2017, the Oregon Health Authority (OHA) will reconsider its ruling that eliminated coverage for epidural steroid injections. The OHA's  Health Evidence Review Commission’s Evidence-based Guidelines Subcommittee will meet to review and discuss the initial draft coverage guidance “Low Back Pain: Minimally Invasive and Non-Corticosteroid Percutaneous Interventions” and revised coverage guidance “Low Back Pain: Corticosteroid Injections.”

It is critical that interventional pain physicians and their patients are in the room to make their voices heard.

The meeting takes place on April 6, 2017, from 2:00 to 5:00 p.m at the Clackamas Community College Wilsonville Training Center, Room 111-112, 29353 SW Town Center Loop E, Wilsonville, Oregon 97070.

To listen-in only (with no opportunity to comment):

  • Call 888-204-5984 and enter participant code 801373, or
  • Listen via the web by registering here

The non-corticosteroid percutaneous interventions evidence sources cited by OHA are listed on their blog. It is anticipated that the initial draft coverage guidance will be available in agenda materials and posted one week prior to the meeting.

For more information about the meeting from OHA, visit the committee’s website.

For details about SIS advocacy on coverage issues in Oregon, click here.

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Hope for Patients in Oregon State (February 7, 2017)

After hearing statements on February 2nd from physicians (including SIS members), patients, and experts, the Oregon Health Authority’s (OHA) Evidence-based Guidelines Subcommittee (EbGS) has elected to reconsider its initial ruling, and explore more thoroughly the research that demonstrates lumbar radicular pain relief provided by transforaminal epidural steroid injections.

On July 1, 2016, without awaiting release of the coverage guidance under development by the OHA’s Health Evidence Review Commission (HERC), OHA eliminated coverage for epidural steroid injections, leaving thousands of patients  covered by Oregon Health Plan without access to any interventional spine procedures. Most no longer have access to surgery and none have the option of palliative care with long-term opioid treatment. OHA currently recommends acupuncture, manipulation, massage, medications (excluding long-term opioid treatment), cognitive behavioral therapy, physical therapy/occupational therapy, and yoga as the only viable treatments for back pain. On November 8, 2016, the HERC issued draft coverage guidance strongly recommending against coverage for epidural, facet joint, medial branch, and sacroiliac joint corticosteroid injections for low back pain regardless of etiology.

On December 8, 2016 SIS and 10 other medical society members of the Multisociety Pain Workgroup (MPW) warned about the likely negative consequences from the flawed coverage guidance and inappropriate coverage determination. SIS would like to thank the MPW societies for supporting these procedures and signing-on to several comment letters this past year. 

A special note of gratitude to the physicians and patients who attended the OHA meetings to advocate for access to these invaluable procedures. Your voices were heard and we hope the message you conveyed will be instrumental in regaining access to interventional spine procedures.

SIS remains committed to preserving patient access to safe and effective procedures, and with the support of SIS members, we will continue to advocate for patients and physicians in Oregon State and wherever coverage is threatened.

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February 2, 2017 Is Your Chance to Help Oregon Regain Access to Interventional Spine Procedures (January 4, 2017)

The Oregon Health Authority (OHA) announced that two draft coverage guidances are on the agenda for the Health Evidence Review Commission (HERC) Evidence-based Guidelines Subcommittee meeting on February 2, 2017. The recently published draft coverage guidance on corticosteroid injections for low back pain will be discussed, along with feedback received during the public comment period last fall.

Patients on Medicaid in the state of Oregon no longer have access to ANY evidence-based interventional spine procedures for back pain. Most no longer have access to surgery and none have the option of palliative care with long-term opioid treatment. What are they left with? OHA now recommends acupuncture, manipulation, massage, medications (excluding long-term opioid treatment), cognitive behavioral therapy, physical therapy/occupational therapy, and yoga as the only viable treatments for back pain.

On December 8, 2016 SIS and 10 other medical societies warned about the likely negative consequences from the flawed coverage decision. And, on November 22, 2016, SIS suggested ways for you and your patients to take action. Now may be your final chance to take that action.

What you can do:

  • Contact your local newspaper and news stations and make your community aware of this important issue.

  • Let OHA know what you think. On social media mention OHA and use the hashtag #saveinjections.

  • Find your congressional representatives' contact information, and demand action. Visit: https://www.oregonlegislature.gov/findyourlegislator/leg-districts.html.

  • Attend the OHA meeting and sign up to provide verbal comments.

    The meeting will occur February 2, 2017 from 2:00 to 5:00 pm at the Clackamas Community College Wilsonville Training Center, Room 112, 29353 SW Town Center Loop E, Wilsonville, Oregon 97070.

    We encourage you to sign up to provide verbal comments. Each commenter who signs up indicating a wish to testify will be invited to testify at the appropriate time. Due to time constraints, such comment may be limited to five minutes per topic (shared among all those who wish to testify). Commenters are encouraged to bring 15 copies of their complete testimony in written form to the public meeting and be prepared with one- and three-minute highlights of their testimony in case time is limited. For more information about the meeting, visit the committee’s website.

    Can’t make the meeting in person? Follow the proceedings in real-time. On February 2, 2017 call the public listen-in only line: 1-888-204-5984, (participant code 801373) or register for the webinar stream.

Make your voice heard and be your patients’ advocate. But don't stop there. Encourage your patients to do the same. Without reasoned protest from all those affected, many of your patients will be left without effective treatment options and relegated to lives plagued by chronic pain and disability.
 
Click here for suggested talking points for you and your patients to use in your efforts to convey the importance of regaining access to interventional spine procedures. Please contact SIS if you need additional assistance or to share information about your advocacy efforts.

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SIS and 10 Other Societies Warn About Cascade of Negative Consequences From Flawed Coverage Decision (December 8, 2016)

On December 8, 2016, 11 medical specialty societies issued a harsh rebuke to the Oregon Health Authority (OHA) for egregiously denying corticosteroid injection coverage for low back pain. The multi-society response highlights significant flaws in OHA’s coverage guidance methodology, includes citations on the effectiveness of injections, and warns of expected negative consequences of eliminating access to interventional spine procedures including: unnecessary suffering, additional drug dependency, unnecessary surgeries, increased utilization of more expensive therapies, and additional work disability. Read the full response.

The Spine Intervention Society convened the medical societies and coordinated this response, and urges you to take individual action. Click here to see how you can play a role in preserving these valuable treatments.

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Take Action Now! Help Your Patients Regain Access to Interventional Spine Procedures (November 22, 2016)

Patients on Medicaid in the state of Oregon no longer have access to ANY evidence-based interventional spine procedures for back pain. Most no longer have access to surgery and none have the option of palliative care with long-term opioid treatment. What are they left with? The Oregon Health Authority (OHA) now recommends acupuncture, manipulation, massage, medications (excluding long-term opioid treatment), cognitive behavioral therapy, physical therapy/occupational therapy, and even yoga as the only viable treatments for back pain.

SIS and the 13 other member associations of the Multi-Society Pain Workgroup (MPW) are continuing to develop a coordinated a response to this critical oversight, but now is the time for you to act!

 What you can do:

Make your voice heard and be your patients’ advocate. But don't stop there. Encourage your patients to do the same. Without reasoned protest from all those affected, many of your patients will be left without effective treatment options and relegated to lives plagued by chronic pain and disability.

Share your concerns and stories. Follow these suggestions for talking points for you and your patients to use in your efforts to convey the importance of regaining access to interventional spine procedures:

PHYSICIANS/HEALTH CARE PROVIDERS

  1. Interventional spine procedures (injections/RFN) are critical tools in my toolbox.
    • Spine injections have helped hundreds/thousands of my patients regain quality of life.
    • These procedures are safe and effective and can help appropriately selected patients.
    • Share a specific patient success story.
  2. Without these treatments, what are my patients left with?
    • Interventional spine procedures are indicated when conservative treatments have failed. 
    • When we have procedures that can help, how can I tell my patients experiencing terrible pain and unable to do the most basic things that all I can offer is an Advil and yoga?
    • What will happen to my patients who don’t have access to procedures that will help them?

PATIENTS

  1. Share your own story or that of a friend/family member.
  2. How will your life be affected if these procedures are no longer available?

Please contact SIS if you need additional assistance or to share information about your advocacy efforts.

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Immediate Action Required to Fight for Corticosteroid Injection Coverage in Oregon (November 10, 2016)

On July 1, 2016, without awaiting release of the coverage guidance under development by the Health Evidence Review Commission (HERC) of the Oregon Health Authority (OHA), OHA eliminated coverage for epidural steroid injections, leaving thousands of patients without access to any interventional spine procedures. On November 8, 2016, the HERC issued draft coverage guidance strongly recommending against coverage for epidural, facet joint, medial branch, and sacroiliac joint corticosteroid injections for low back pain regardless of etiology. OHA will consider public comments received through 8am (PST) on December 9, 2016, and SIS encourages all interested parties to make their voices heard. 

What You Can Do
Let OHA know what you think. On social media mention OHA and use the hashtag #saveinjections.
Encourage your patients who have benefited from these invaluable procedures to make their voices heard as well.

Comments may also be submitted to the OHA HERC by emailing HERC.Info@state.or.us. Be sure to visit the OHA HERC Coverage Guidance page for specific comment instructions.

What SIS is Doing
SIS is currently reviewing the coverage guidance and leading an effort to coordinate a response with the 13 other member associations of the Multi-Society Pain Workgroup (MPW) which represents over 100,000 stakeholders dedicated in whole or in part to interventional pain management.

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SIS Provides Comment on Two Oregon Health Authority (OHA) Draft Scope Statements (July 27, 2016)

NEW ORLEANS, La.—July 27, 2016—The Spine Intervention Society’s President, John MacVicar, MB ChB, offered to provide expert input to the Oregon Health Authority (OHA) to assist in their efforts to identify effective spinal intervention procedures.

Specifically, SIS has provided comment on two draft scope statements for coverage guidance development: Minimally Invasive and Non-Corticosteroid Percutaneous Interventions, and Lumbar Discography.

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SIS Coordinates 14 Society Response to the Oregon Health Authority’s Decision to End ESI Coverage (May 19, 2016)

HINSDALE, Ill.—May 19, 2016—On behalf of 14 medical specialty societies that comprise physicians who utilize and/or perform spinal injection procedures to accurately diagnose and treat patients suffering from spine pathologies, SIS has submitted comments regarding Oregon Health Authority’s decision to eliminate coverage of epidural steroid injections (ESIs) effective July 1st.

ESIs have an established record of safety and effectiveness, and a cascade of unintended consequences may stem from this decision including unnecessary suffering, further opioid dependency, avoidable invasive surgeries, increased utilization of added healthcare resources, and a diminishment of productivity due to greater employment disability claims. Read the multi-society response letter here.

Once again, SIS has taken the lead to coordinate a response to an emerging challenge spine interventionists face in guaranteeing access and reimbursement for clinically appropriate, patient-oriented care. Learn more about SIS advocacy efforts here.

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ESI Coverage in Oregon Will End Without Your Immediate Action (May 12, 2016)

On May 11, 2016, SIS submitted comments to the Oregon Health Authority regarding their decision to eliminate coverage of epidural steroid injections (ESIs) effective July 1st.

Oregon physicians and stakeholders are encouraged to attend and present public comments at the OHA’s Value-based Benefits Subcommittee (VbBS) meeting on Thursday, May 19th from 8:30 am – 1:00pm. To present public comments, stakeholders should arrive by 12:45 pm. The VbBs will not be addressing this topic specifically, but will hear comments.

Any SIS members interested in attending this meeting and attempting to provide comment are encouraged to contact SIS staff to obtain an outline of key points.

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Make Your Voice Heard Before Patients in Oregon Lose Coverage for Epidural Steroid Injections (May 9, 2016)

The Oregon Health Authority (OHA) recently announced that, effective July 1, 2016, the state will no longer cover epidural steroid injections as a treatment for conditions of the back and spine. This change occurs without any official public comment period and does not align with the recommendations in the coverage guidance developed by the OHA’s Health Evidence Review Commission (HERC). In fact, the HERC is undertaking a revision of their coverage guidance on percutaneous interventions for low back pain, with publication of a draft guidance anticipated in late 2016 or early 2017; SIS submitted comments on the HERC’s proposed scope/questions in January 2016.

On Thursday, May 19th,  two meetings are scheduled that include opportunity for public comment. The OHA’s Value-based Benefits Subcommittee (VbBS) will meet from 8:30am – 1:00pm; the Health Evidence Review Commission (HERC) will meet from 1:30-4:30 pm. SIS encourages interested Oregon physicians and stakeholders to attend and sign up to provide verbal comments at the meeting, though time may be limited per the OHA’s policy. Written comments may also be submitted by May 12th.

SIS will be submitting comments regarding the value of epidural steroid injections and highlighting concerns about the OHA’s flawed process. Any SIS members interested in attending this meeting and attempting to provide comment are encouraged to contact SIS staff to obtain a copy of our letter and an outline of key points.

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SIS Comments on Oregon Health Authority's Coverage Guidance on Percutaneous Interventions (January 19, 2016)

On January 19, SIS submitted comments to the Oregon Health Authority on their Scope Statement for the development of a Coverage Guidance on Percutaneous Interventions for Low Back Pain. The scope statement defined the populations, interventions, comparisons and the outcomes that were considered most important in determining whether changes to the existing coverage guidance are warranted. The current Coverage Guidance indicates that the topic will be reviewed following publication of the AHRQ technology assessment on spinal injections for low back pain. SIS’ comments highlight the AHRQ report's significant methodological flaws and urges Oregon Health Authority to be aware of these errors and not repeat them.

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Oregon HTA Discusses Draft Coverage Guidances on Percutaneous Interventions for Cervical Spine Pain (April 10, 2014)

The Oregon Health Technology Assessment Subcommittee will meet on April 28th to discuss draft coverage guidances on various topics, including Percutaneous Interventions for Cervical Spine Pain.  At the February 24th meeting, the Subcommittee requested additional research on the topic. On April 4th, it was announced that two additional sources would be added to the draft coverage guidance based on expert input .  ISIS members in Oregon are encouraged to become involved and attend the April 28th meeting. Please contact advocacy@spineintervention.org if you are planning to attend. For the meeting agenda and materials, visit: http://www.oregon.gov/oha/herc/Pages/blog-cervical-spine-interventions.aspx and http://www.oregon.gov/oha/herc/Pages/Upcoming.aspx#htas

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SIS Oregon Members Encouraged to Attend Meeting on Cervical Spine Injections (February 25, 2014)

The Oregon Health Technology Assessment Subcommittee will meet on Monday, February 24; the agenda includes a review of initial draft coverage guidances on cervical spine injections. SIS members in Oregon are encouraged to become involved and attend the meeting. Please contact advocacy@spineintervention.org if you are planning to attend. For the meeting agenda and materials, visit http://www.oregon.gov/oha/herc/Pages/Upcoming.aspx#htas.

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SIS Defends Spine Interventions in Oregon (September 20, 2012)

The Oregon Health Evidence Review Commission (HERC) has issued a draft coverage guidance for percutaneous interventions for low back pain. The draft proposal would drastically limit patient access to valuable spine intervention procedures. To view the draft document click here

SIS alerted all Oregon members and encouraged them to submit comments during public comment period.  An official ISIS letter has been submitted to the HERC, as well.  To view the letter, please click here

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Urgent Message to SIS Members in the State of Oregon (September 5, 2012 )

The Oregon Health Evidence Review Commission (HERC) has issued a draft coverage guidance for percutaneous interventions for low back pain. There are many points in this document that are very alarming and will drastically limit patient access to valuable spine intervention procedures. 

SIS members are strongly encouraged to submit comments by September 7, 2012 deadline. 

The draft coverage guidance can be viewed at:
http://cms.oregon.gov/oha/OHPR/HERC/docs/CG/PI-LBP.pdf 

According to the HERC website, below are the requirements for public comments: 

"For your comment to be accepted, it must:

  • be submitted to HERC.Info@state.or.us by the listed deadline.
  • include the name of the guidance in the subject line of your email.
  • include your name, profession, address, phone number and email address (only your profession, location, and comments will be made publicly available).
  • not exceed 1000 words.

Effective June 1, 2012, any submissions not adhering to the above criteria will be returned without an extension of the deadline.

Only one submission per person, per topic will be allowed and a separate email must be sent for each topic.

Comments should include a full citation to any suggested additional peer-reviewed articles (not counted towards the 1000 word limit). To ensure the suggested articles are reviewed, you should attach copies of the articles with your comments. If we are unable to obtain a cited article, we will not review the study.

Comments should not contain links to additional materials. These will not be reviewed.”


If you would like to volunteer to be involved on a greater level and volunteer to attend HERC public hearing (s). Please send an email to advocacy@spineintervention.org.

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Washington Health Care Authority

Multisociety Support for SIS Member Nominee to Committee of the Washington Health Care Authority (June 6, 2017)

The Spine Intervention Society, with the support of the American Academy of Physical Medicine and Rehabilitation and the Society of Interventional Radiology, has nominated Dr. Virtaj Singh to serve on the Washington Health Care Authority Health Technology Assessment Program’s Health Technology Clinical Committee.  Click here to read the nomination letter.

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WA Health Technology Clinical Committee’s Decision to Preserve Coverage for Spinal Injections (March 24, 2016)

Press Release by the American Society of Anesthesiologists:

March 23, 2016

Chicago – The Multi-society Pain Workgroup (MPW), representing more than 100,000 physicians and 15 medical societies, applauds the Washington State Health Care Authority’s Health Technology Clinical Committee (HTCC) for preserving access to spinal injection therapies for millions of people who suffer from back pain. 

On March 18, the HTCC held a hearing to determine coverage of spinal injections for Medicaid enrollees, Labor and Industries and state employees. The MPW worked together throughout the past year submitting extensive comments in support of these procedures. The HTCC’s decision could have national implications as other states decide whether to cover these procedures.

“I would like to extend my deepest gratitude to all of the MPW societies for lending their voices in support of continued access to spinal injection procedures that are critical to preserving patient quality of life. The collaborative effort and voices of more than 100,000 multidisciplinary pain specialists was heard loud and clear,” said Paul Dreyfuss, M.D., former chair of the MPW and clinical professor at the University of Washington, who presented at the hearing. “These therapies, when performed correctly with contemporary techniques, provide patients with significant pain relief, improved function and quality of life.”

It is estimated that 80 percent of people experience back pain at some time in their life and more than 100 million Americans suffer from chronic pain. Some patients suffering from chronic pain have failed more conservative therapies such as medications and physical therapy. In some cases, alternatives such as non-steroidal anti-inflammatory medications (NSAIDs) and opioids have the potential for serious adverse effects such as gastrointestinal (GI) bleeding, abuse, addiction and death. 

The decision to retain coverage of spinal injection therapies is consistent with the scientific evidence supporting safety and efficacy. 
Maintaining access to spinal injection therapies can provide patients with the significant benefits of pain relief, improved function and quality of life, reducing their need for surgery or opioids, which is particularly important in light of the national opioid abuse epidemic.

The Multi-society Pain Workgroup is comprised of the following societies:
American Academy of Pain Medicine
American Academy of Physical Medicine and Rehabilitation
American Association of Neurological Surgeons
American College of Radiology
American Pain Society
American Society of Anesthesiologists
American Society of Neuroradiology
American Society of Regional Anesthesia and Pain Medicine
American Society of Spine Radiology
Congress of Neurological Surgeons
North American Neuromodulation Society
North American Spine Society
Society of Interventional Radiology
Spine Intervention Society
Washington State Association of Neurological Surgeons*

*WSANS represents neurosurgeons in the state of Washington, but is not an official member of the MPW.

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A Victory for Patients and Physicians in Washington State! (March 18, 2016)

We are pleased to report that, after Spine Intervention Society (SIS) volunteers and staff invested hundreds of hours working to ensure coverage of spinal injection procedures in Washington State, patient access to these invaluable procedures has been preserved!

The Washington State Health Care Authority’s Health Technology Clinical Committee (HTCC) met today to hear public comment and determine coverage of spinal injections for patients in Washington State. They voted to maintain coverage and patients will retain access to spinal injection procedures critical to their health and quality of life.

We would like to thank the Multisociety Pain Workgroup (MPW) societies for supporting these procedures and signing-on to several comment letters this past year. A special note of gratitude to Dr. Paul Dreyfuss and SIS Health Policy Division members, Drs. Brandon Messerli and Virtaj Singh, for their tireless commitment and invaluable efforts at the local level.

SIS is committed to preserving patient access to safe and effective procedures. We commend the HTCC on making their coverage decisions based upon the best available evidence, which clearly demonstrates that spinal injection procedures are safe and effective.

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WA HCA Decision on Spinal Injections Looms (March 14, 2016)

The fate of spinal injection procedures in the state of Washington will be decided at the March 18 meeting of the WA Health Care Authority's Health Technology Clinical Committee. The Spine Intervention Society has submitted extensive comments at every stage of their review and SIS representatives will be in attendance. Updates will be provided as indicated.

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WA HCA Releases Final Evidence Report on Spinal Injections (February 17, 2016)

On February 12, the Washington State Health Care Authority's Health Technology Assessment program published its final report of their re-review of spinal injections. The report is available at the Washington State Health Care Authority Health Technology Assessment Page. A public meeting of the Health Technology Clinical Committee is scheduled for March 18, 2016. The Spine Intervention Society has submitted comments at every stage of this report's development and release.


A team of dedicated SIS Health Policy Division members in Washington State is working to organize efforts to ensure a strong presence and cohesive presentations at the HTCC meeting. 
For more information, please contact the Washington State team at htaspine@gmail.com.

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ATTENTION WASHINGTON PHYSICIANS: Save the Date! March 18 WA HCA HTCC Meeting (January 19, 2016)

On Friday, March 18 at the SeaTac Conference Center, the WA Health Technology Clinical Committee (HTCC) will meet from 8 am to 5 pm, and preliminary information indicates that spinal injections will be addressed in the afternoon, likely starting at 12:30 pm.

Five weeks prior to the March meeting (Feb 12), Health Care Authority stakeholders will be notified of the opportunity to present comments at the meeting. Individuals will have three minutes each to make their comments. Groups may “pool” their individual time to allow one or two of their representatives to speak longer. In this case, all individuals whose time is pooled must be present at the meeting whether they speak or not.

For more information, see the WA HCA HTCC page.

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Comments Submitted on WA HCA Health Technology Assessment on Spinal Injections (January 19, 2016)

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 in response to the call for comments on their 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). SIS and the other signatories believe that the current draft of the report does not adequately address the key questions posed and is not a satisfactory reference for the topic.

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Draft WA HCA Health Technology Assessment on Spinal Injections Released (December 16, 2015)

Earlier this year, the WA HCA announced the draft key questions that will frame their re-review of spinal injections. The draft report is anticipated to be released on 12/16/15 at the Washington State Health Care Authority Health Technology Assessment page. Public comments will be accepted between December 16 and January 14; the Spine Intervention Society will review and comment on the report on behalf of the membership.

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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.

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Comments Submitted to Washington State HCA Regarding Plan to Review Spine Injections (January 23, 2015)

On January 20, the Society submitted comments to the Washington State Health Care Authority (HCA) regarding their recommendation that the Health Technology Clinical Committee (HTCC) re-review the topic of spine injections.  The letter raises concerns about the basis of HCA’s recommendation, namely, the 2014 Friedly et al. paper regarding the use of epidural steroid injections for spinal stenosis as well as the April 2014 FDA warning regarding the use of steroids in the epidural space.

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WA HTCC Draft Coverage Determination – Facet Neurotomy – Open for Comments (April 10, 2014)

The Washington State Health Care Authority (HCA) Health Technology Clinical Committee (HTCC) has released for public comment its Draft Findings and Decision for Facet Neurotomy, based on a public meeting held on March 21.

Two Society members from Washington State, Drs. Paul Dreyfuss and Alison Stout, attended in person and made very compelling arguments for appropriate coverage. SIS also submitted extensive comments on this topic, encouraging the HTA to incorporate best available evidence.  As a result, the committee decided to cover some, but not all, of the procedures advocated by SIS.  

SIS is preparing a response to the draft coverage determination. SIS members, particularly those residing in Washington, are encouraged to comment.  The deadline for comment submission is April 22.

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Washington State Health Care Authority Reviewing Facet Neurotomy – SIS Submits Comments; Public Meeting (February 25, 2014)

On December 19, 2013, the Washington State Health Care Authority (HCA) released for public comment a draft evidence report on facet neurotomy. According to the HCA’s website, "there are significant questions related to the diagnosis and treatment of facet joint pain including if it is safe, effective and cost-effective and the most effective means of identifying patients who may benefit.” SIS submitted comments to the HCA on Friday, January 17, 2014, encouraging the Washington HCA to focus on the evidence and the proper application of ISIS guidelines as the standard for the performance of medial branch blocks, third occipital nerve blocks, and thermal radiofrequency neurotomy. The ISIS comment letter is available here. The public meeting of the Health Technology Clinical Committee (HTCC) in which Facet Neurotomy will be discussed will take place on March 21, 2014.

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SIS Comments on the Washington State Health Care Authority Draft Report on Facet Neurotomy (January 24, 2014)

On December 19, 2013, the Washington State Health Care Authority (HCA) released for public comment a draft evidence report on facet neurotomy. According to the HCA’s website, "there are significant questions related to the diagnosis and treatment of facet joint pain including if it is safe, effective and cost-effective and the most effective means of identifying patients who may benefit.” ISIS submitted comments to the HCA on Friday, January 17, 2014, encouraging the Washington HCA to focus on the evidence and the proper application of ISIS guidelines as the standard for the performance of medial branch blocks, third occipital nerve blocks, and thermal radiofrequency neurotomy.
 
The comment letter is available here.

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SIS Responds to the HTA Public Comment Request on Evidence for Cervical and Lumbar Neurotomy (January 24, 2013)

The Washington State Health Technology Authority announced that Cervical and Lumbar Facet Neurotomy would be reviewed in 2013. Preliminary comments on evidence were being sought. SIS submitted a summary of new information and will be involved in providing comments as the process progresses. To view the comment letter please click here.

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WA HCA announces Review of Facet Neurotomy (December 21, 2012)

The Washington State Health Care Authority (HCA) Director has selected a group of health technologies to undergo review and coverage decisions by the Health Technology Clinical Committee (HTCC) beginning in 2013.  On this list the HCA placed Facet Neurotomy for Cervical and Lumbar Pain.

To gather information and evidence for consideration in review of the selected topics, public comments will be accepted by the HCA until January 10, 2013 at 5pm. All comments should be submitted to: shtap@hca.wa.gov.

SIS has been very heavily involved with the WA HCA’s review of spinal injections and due to those efforts majority of the procedures reviewed at the time continue to be covered. We will again do everything possible to assure appropriate coverage and access to facet neurotomy for our patients.

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COMMENT LETTERS

The Society’s membership includes many of the clinicians and academicians whose published literature provides the seminal references upon which the practice of evidence-informed interventional spine care is based. Our organization has a strong record of working to eliminate fraudulent, unproven, and inappropriate procedures. At the same time, we are equally committed to assuring that appropriate, effective, and responsible treatments are preserved so that patients do not have to suffer or undergo more invasive and often unnecessary surgical procedures. To that end, the SIS Health Policy Division's Coverage Committee regularly reviews and submits comments regarding coverage policies that are inconsistent with the literature and SIS guidelines.

Epidural Injections

SIS Recommends Changes to Humana's Medical Coverage Policy on Injections for Chronic Pain Conditions (April 14, 2017)

The Spine Intervention Society (SIS) recently recommended changes to the Humana medical coverage policy on injections for chronic pain. The letter suggests multiple changes to coverage criteria to ensure that appropriately-selected patients have access to these valuable procedures.

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SIS Comments on Blue Shield of California’s Policy on Epidural Steroid Injections (April 7, 2017)

On April 4, 2017, the Spine Intervention Society commented on Blue Shield of California’s epidural steroid injection (ESI) coverage policy, which classifies full anticoagulation as a contraindication for epidural injections. While evidence has demonstrated a risk of hemorrhagic complications in anticoagulated patients undergoing interlaminar ESI, the same cannot be said for lumbar transforaminal epidural steroid injections. For lumbar transforaminal injections, there may actually be more risk in discontinuing anticoagulants, increasing the risk for vascular or cerebrovascular events. Read the SIS comment letter for further details.

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SIS Recommends Changes to Novitas Provider Qualification Determinations (November 3, 2016)

On November 2, 2016, SIS submitted a letter to Novitas Solutions, a U.S. Medicare administrative contractor, encouraging the company to reconsider provider qualifications in their Epidural Injections Local Coverage Determination (LCD) to stipulate that only appropriately trained physicians should perform spine intervention procedures.

SIS commends Novitas on addressing the vast majority of suggestions made in a March 2016 comment letter but insists that rendering appropriate care to avert devastating injury is well beyond the scope of physician extenders, such as physician assistants and nurse practitioners. Read the November 2016 letter for additional details.

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SIS Comments on Majoris Guidelines that Exclude Some Cervical ESIs (October 17, 2016)

On October 6, SIS submitted comments to Majoris Health Systems on their treatment guidelines for epidural steroid injections. The comments focused specifically on the current policy’s exclusion of cervical ESIs, with the exception of transforaminal ESIs at the C6-C7 level using non-particulate steroid formulations. To see the letter, click here.

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SIS Submits Comments to UnitedHealth Group on Bilateral Procedures Policy Revisions (May 17, 2016)

On May 10, SIS submitted comments to UnitedHealth Group regarding their revisions to their bilateral procedures policy scheduled for implementation in Q2 2016 that inappropriately applies the Centers for Medicare and Medicaid Services' (CMS) payment adjustment methodology to add-on codes for bilateral procedures. SIS urges UnitedHealth Group to reconsider this policy change and recognize that all add-on codes are exempt from the multiple procedure reduction concept. Our colleagues at the American Academy of Physical Medicine and Rehabilitation brought this issue to our attention and SIS echoes their comments as well. See the letter here.

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SIS Submits Comments on Novitas Draft LCD on Lumbar Epidural Injections for Pain Management (March 14, 2016

On March 3, 2016, SIS submitted comments on the Novitas draft LCD #DL34892 Lumbar Epidural Injections for Pain Management. The comment letter noted several recommendations for revision within the LCD.

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SIS Sends Comments to CIGNA (December 16, 2015)

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.

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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 SIS 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 SIS click here.

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SIS Provides Comments on Colorado Workers’ Compensation Guidelines (November 22, 2013)

SIS 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 SIS members testified. To review the letter SIS submitted to the Colorado Workers Compensation click here

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

An SIS 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 SIS 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.

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Facet Interventions

SIS Suggests Revisions to BCBS Coverage Policy on Facet Joint Injections (May 25, 2017)

The Spine Intervention Society (SIS) recently reviewed and commented on a BlueCross Blue Shield coverage policy addressing facet joint injections.  The policy affects patients in five states—Illinois, Montana, New Mexico, Oklahoma, and Texas. The letters suggest multiple changes to coverage criteria to ensure that appropriately-selected patients have access to these valuable procedures.

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sIS Recommends Changes to UHC’s Medical Coverage Policy on Ablative Treatments for Spinal Pain (April 28, 2017)

The Spine Intervention Society (SIS) recently recommended changes to the United Healthcare medical coverage policy on ablative treatments for spinal pain. The letter recommends coverage of third occipital nerve (C2-3) radiofrequency neurotomy treatment for headache and occipital neuralgia, and provides a detailed summary of the evidence of effectiveness in appropriately selected patients.

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SIS Recommends Changes to Humana's Medical Coverage Policy on Injections for Chronic Pain Conditions (April 14, 2017)

The Spine Intervention Society (SIS) recently recommended changes to the Humana medical coverage policy on injections for chronic pain. The letter suggests multiple changes to coverage criteria to ensure that appropriately-selected patients have access to these valuable procedures.

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SIS Recommends Changes to the Facet Joint Intervention Coverage Policy of BlueCross and BlueShield of Alabama (April 5, 2017)

The Spine Intervention Society (SIS) recently recommended changes to the facet joint intervention coverage policy of BlueCross and BlueShield of Alabama. The letter suggest multiple changes to coverage criteria to ensure that appropriately-selected patients have access to these valuable procedures.

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SIS Recommends Changes to BlueCross BlueShield of Tennessee's Facet Joint Intervention Coverage Policy (April 5, 2017)

The Spine Intervention Society (SIS) recently recommended changes to the facet joint intervention coverage policy of BlueCross BlueShield of Tennessee. The letter suggest multiple changes to coverage criteria to ensure that appropriately-selected patients have access to these valuable procedures.

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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.

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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 to address confusion within the payer community about the tissue temperatures achieved by cooled radiofrequency neurotomy.

On March 20, 2017, SIS issued a comment letter 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.

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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.

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SIS and NASS Issue Joint Recommendations to Improve CGS Local Coverage Determination (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.

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SIS Finds Anthem/Blue Cross Blue Shield RFN Coverage Policy Lacking, Suggests Improvements (October 17, 2016)

On October 6, SIS submitted comments to Anthem/Blue Cross Blue Shield on their coverage policy for percutaneous radiofrequency neurotomy (RFN) of the medial branches in the treatment of zygapophysial joint pain. SIS commented that the requirement that “the absence of nerve root compression is documented in the medical record on history, physical, and radiographic evaluations” is not appropriate. To see the letter, click here.

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SIS Comments on BCBS of IL Facet Joint and Sacroiliac Joint Denervation Policy (June 14, 2016)

On May 31, SIS submitted comments to BlueCross BlueShield of Illinois regarding their pending Facet Joint and Sacroiliac Joint Denervation policy scheduled for implementation on June 15, 2016. The proposed medical policy specifically excludes third occipital nerve (C2-3) denervation or radiofrequency neurotomy (RF), suggesting that there is insufficient evidence to support its use. This is not consistent with the evidence in the literature and our letter offers an explanation for the recommendation that for patients with suspected pain arising from the C2-3 zygapophysial joint, who have achieved greater than 80% relief of index pain with dual diagnostic blocks using appropriate techniques, third occipital nerve RF neurotomy is a proven, effective procedure. Read the comment letter here.

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SIS Submits Comments to UnitedHealth Group on Bilateral Procedures Policy Revisions (May 17, 2016)

On May 10, SIS submitted comments to UnitedHealth Group regarding their revisions to their bilateral procedures policy scheduled for implementation in Q2 2016 that inappropriately applies the Centers for Medicare and Medicaid Services' (CMS) payment adjustment methodology to add-on codes for bilateral procedures. SIS urges UnitedHealthcare to reconsider this policy change and recognize that all add-on codes are exempt from the multiple procedure reduction concept. Our colleagues at the American Academy of Physical Medicine and Rehabilitation brought this issue to our attention and SIS echoes their comments as well. See the letter here.

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SIS Sends Comments to Blue Shield of CA (December 16, 2015)

On November 30 2015, 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.

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SIS Sends Comments to CIGNA (December 16, 2015)

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.

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SIS Submits Comments on Novitas Coverage Policy (November 18, 2015)

On November 3, 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.

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SIS Submits Comments on United Healthcare Coverage Policy (November 18, 2015)

SIS recently submitted comments to United Healthcare regarding their Occipital Neuralgia and Headache Treatment, Policy Number: 201570080O.

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SIS Submits Comments on BlueCross and BlueShield North Carolina  Coverage Policy (November 18, 2015)

A letter was submitted to BlueCross and BlueShield North Carolina on November 11, 2015 regarding suggestions to improve the coverage policy to ensure appropriate access to cervical radiofrequency neurotomy.

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

Two Society members, Drs. Paul Dreyfuss and Ray Baker, met with the medical director of Premera Blue Cross insurance plan on March 28, 2014 to discuss Premera’s decision to not cover C 2-3 facet radiofrequency neurotomy.  As a result of the meeting, during which the scientific evidence was presented, Premera issued a new policy providing coverage for C 2-3 facet RF neurotomy. 

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SIS Provides Comments on Colorado Workers’ Compensation Guidelines (November 22, 2013)

SIS 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 SIS members testified. To review the letter SIS submitted to the Colorado Workers Compensation click here

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

On November 7, 2013 SIS 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.  ISIS 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.  To see a copy of the letter, click here.

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Sacroiliac Interventions

SIS Urges BCBS of VT to Cover Lateral Branch Radiofrequency Neurotomy for Sacroiliac Joint Pain (JUNE 26, 2017)

BlueCross BlueShield of Vermont’s draft coverage policy Diagnosis and Treatment of Sacroiliac Joint Pain excludes coverage for radiofrequency denervation of the sacroiliac joint, also referred to as lateral branch radiofrequency neurotomy (LBRFN), as an investigational procedure. On June 26, 2017, the Spine Intervention Society issued a comment letter to the insurer suggesting, based on a recently completed multisociety-endorsed set of appropriate use criteria for sacroiliac interventions, that the procedure is an appropriate treatment for suitably selected patients.

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SIS Suggests Revisions to BCBS of AL Coverage Policy on Sacroiliac Joint Pain (May 18, 2016)

SIS recently recommended changes to BlueCross BlueShield of Alabama's medical coverage policy on diagnosis and treatment of sacroiliac joint pain. The letter references the multisociety-developed appropriate use criteria in promoting coverage of lateral branch radiofrequency neurotomy for appropriately selected patients.  

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SIS Comments on BCBS of IL Facet Joint and Sacroiliac Joint Denervation Policy (June 14, 2016)

On May 31, SIS submitted comments to BlueCross BlueShield of Illinois regarding their pending Facet Joint and Sacroiliac Joint Denervation policy scheduled for implementation on June 15, 2016. The proposed medical policy specifically excludes third occipital nerve (C2-3) denervation or radiofrequency neurotomy (RF), suggesting that there is insufficient evidence to support its use. This is not consistent with the evidence in the literature and our letter offers an explanation for the recommendation that for patients with suspected pain arising from the C2-3 zygapophysial joint, who have achieved greater than 80% relief of index pain with dual diagnostic blocks using appropriate techniques, third occipital nerve RF neurotomy is a proven, effective procedure. Read the comment letter here.

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BCBS of Tennessee Updates SIJ Injections Policy to Medically Necessary (June 14, 2016)

SIS member, Dr. Graf Hilgenhurst, informed the Society that BlueCross BlueShield of Tennessee has updated their draft sacroiliac joint policy to move SI joint injections from investigational to medically necessary when certain appropriateness criteria are met. This change represents several years of advocacy by SIS, SIS members in Tennessee, and other specialty society groups.

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SIS Sends Comments to CIGNA (December 16, 2015)

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.

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Neurostimulation

SIS Comments on Proposed NASS Coverage Policy Recommendations on Spinal Cord Stimulation (May 19, 2017)

SIS recently reviewed the North American Spine Society’s (NASS) draft coverage policy recommendations on spinal cord stimulation. The letter commends NASS on the draft and suggests revisions to better describe the rationale for the procedure and address appropriate indications and contraindications.  

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SIS Recommends Changes to BCBS TN Medical Coverage Policy on Spinal Cord Stimulation (April 28, 2017)

The Spine Intervention Society (SIS) recently recommended changes to the BlueCross BlueShield of Tennessee’s (BCBS TN) medical coverage policy on spinal cord stimulation (SCS). The letter commends BCBS TN on covering traditional SCS and presents evidence supporting coverage for high frequency (HF-10) SCS.

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SIS and, Other Societies Submit Comments to California’s Division of Workers’ Compensation (March 14, 2017)

On March 10, 2017, SIS, along with several other Multi-society Pain Workgroup (MPW) member associations and physicians from several academic pain programs in the State of California, sent a joint comment letter to California’s Division Of Workers’ Compensation (DWC) to help injured workers in the State of California maintain access to many effective interventional therapies.

 The DWC proposes to amend the chronic pain chapter of its Medical Treatment Utilization Schedule (MTUS), adopting ill-informed guidelines from the American College of Occupational and Environmental Medicine (ACOEM), which will result in the elimination of access to spinal cord stimulation/neurostimulation and other interventional therapies that have been proven to reduce or eliminate pain and improve function with no or minimal adverse events.

 The letter covers the history of a similar proposal the DWC rejected in 2015, and appendices also include evidence tables.

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SIS Comments on Regence Blue Cross Blue Shield’s Coverage Denial HF10 SCS Therapy (February 6, 2017)

Counter to controlled studies, Regence Blue Cross Blue Shield issued policy number 45: Spinal Cord and Dorsal Root Ganglion Stimulation Medical Policy, that designates high frequency spinal cord stimulation therapy (HF10) as investigational and not covered.
 
On February 3, 2017, the Spine Intervention Society submitted comments to Regence highlighting evidence for the efficacy of HF10 therapy and requested a 24-month delay in the implementation of the policy to allow for further evidence to be published and considered. SIS is also currently addressing this issue with Blue Cross Blue Shield of Massachusetts, as described here.

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SIS Comments on BCBS of Massachusetts’s Coverage Denial of HF10 SCS Therapy (January 31, 2017)

Counter to controlled studies, supportive literature, and clinical experiences, Blue Cross Blue Shield of Massachusetts issued policy number 472 that designates 10 kHz, high frequency spinal cord stimulation therapy (HF10) as investigational and not covered. 

On January 30, 2017, the Spine Intervention Society submitted comments highlighting evidence supporting the efficacy of HF10 and requesting a 24-month delay in the implementation of the policy to allow for further evidence to be published and considered. Additionally, SIS has requested that the comment letter be considered at a Blue Cross Blue Shield policy meeting on January 31, 2017.

Read the comment letter for further details.

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SIS Sends Comments to CIGNA (December 16, 2015)

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.

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Other Interventions

SIS Sends Comments to CIGNA (December 16, 2015)

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.

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