News & Press: Advocacy

CMS Issues Ruling for 2015 Physician Payment

Friday, November 21, 2014  

On October 31st, 2014 Centers for Medicare and Medicaid Services (CMS) released its final rule for the Medicare Physician Fee Schedule for the year 2015 (the Rule).  The Rule is still being reviewed by staff but several highlights of importance to Society members are as follows:

Values of Epidural Injection Codes

One of the most important aspects of the rule is that as of January 1, 2015 CMS is reverting the values of codes 62310, 62311, 62318, and 62319 back to the CY 2013 values. The International Spine Intervention Society, along with other groups, urged CMS to revert back to the 2013 values for that were in effect prior to the 2014 cuts. However, CMS also determined that these codes should be revised and revalued to include (bundle) imaging into the code and, as of January 1, 2015, fluoroscopic guidance (77003) will no longer be paid separately.

To view the multi-society letter submitted to CMS click here and to view the letter submitted by the International Spine Intervention Society click here.

Neurostimulator Code Review

Two neurostimulator codes (64553 and 64555) have been brought to CMS’ attention by a stakeholder who questioned the adequacy of practice expense inputs.  In response, CMS requested that the AMA/Specialty Society Relative Value Scale Update Committee (RUC) review these codes.  This places the entire family of codes at risk for loss of value.  In this final rule, CMS finalized their ruling to classify these codes as potentially mis-valued and made a point of stating that as result review, inputs can be adjusted either upward or downward.

The International Spine Intervention Society actively participates in the AMA/Specialty Society Relative Value Scale Update Committee (RUC) process, providing input on the appropriate valuation of our codes.  We will work diligently during the review of the epidural codes as well as the neurostimulator codes and advocate for appropriate inputs that will result in appropriate values.

Other provisions of interest in the Rule include:

  • Publication of the expected cut to physician fees as a result of the sustainable growth rate (SGR) formula. 

The cut this year is projected at 21.2 percent.  This is down from previous years when the cut was projected around 30 percent.  This indicates flattening of growth in utilization of physician services.  It is expected that another battle will take place in the month of December to avert the cut by Congressional action.

  • Conversion of the Physician Quality Reporting System (PQRS) from a bonus payment program to penalty-only program. 

In 2015 physicians must successfully report at least nine quality measures across three domains and at least one cross-cutting measure to avoid a payment penalty in 2017.

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