New Jersey Society of Interventional Pain Physicians

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Dr. Woska being honored for his service to our society as the Executive Director for the past 5 years. We congratulate him for all the time and effort that he put forth and the excellent job that he did.

 

 

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URGENT - Medicare proposed reduction in sacral and knee RF reimbursement

 

This topic was discussed the NJSIPP meeting on Wednesday night. It is Urgent you respond - there are only 10 days left!!!

 

Medicare has proposed to significantly decrease the payment rates for both the physician and the facility setting for the new knee and SIJ radiofrequency ablation CPT codes that are effective January 1, 2020. These new codes will impact all RFA technologies, both cooled and conventional.

 

We encourage you to:

1.       review the proposed rules and provide comments to Medicare. The deadline for comments is September 27, 2019. Links to the proposed rules and information on how to submit comments are noted at the end of this e-mail. It is very important that Medicare receives comments from as many stakeholders as possible before the Final Rules are released later this year.

2.       connect with your societies who participated in the new CPT code development process to express your concerns and encourage them to comment on the proposed rules as well.

Here are some important key facts from the proposed rules:

 

KNEE RFA IMPACTS

  • Physician Rule – The proposed physician RVU valuation for the new CPT code for RFA in the knee has significantly decreased from the current peripheral nerve ablation RVUs. Avanos believes the reduction in rate is not appropriate and will likely result in a decrease in usage of this non-opioid alternative to treating pain. Avanos plans to raise this issue in its comment letter.
  • Physician & HOPD Rules – The new Knee RFA CPT code was developed to report 3 nerve ablations during a single procedure versus the current peripheral nerve ablation code where reporting is on a per ablated nerve basis.
  • HOPD Rule – The hospital outpatient facility payment for the knee RFA procedure has significantly decreased. The new knee RFA CPT code was assigned to the Nerve “Injection” APC (Ambulatory Payment Classification) unlike the new SIJ procedure CPT code which was assigned to the Nerve “Procedure” APC. Avanos believes that the knee RFA procedure should be properly placed in the Nerve Procedure APC and intends to address this in its comment letter.

The following table provides a snapshot of the proposed changes in Medicare National average payment rates:

Knee RFA.JPG

SIJ RFA IMPACTS

  • Physician Rule – The proposed physician RVU valuation for the new code for SIJ RFA procedures has significantly decreased from the current peripheral nerve ablation RVUs. Avanos believes the reduction in rates is not appropriate and will likely result in a decrease in usage of this non-opioid alternative to treating pain. Avanos plans to raise this issue in its comment letter.
  • Physician & HOPD Rules – The new SIJ RFA CPT code was developed to report 3 nerve ablations during a single procedure versus the current peripheral nerve ablation code where reporting is on a per ablated nerve basis.
  • The following table provides a snapshot of the proposed changes in Medicare National average payment rates.

SIJ RFA.JPG

 

Submit your online comments related to CMS Proposed HOPD:

Submit electronic comments on this HOPD regulation to:

or

Follow the instructions under the “Comment Now” tab. Reference Rule CMS-1717-P.

 

Submit your online comments related to CMS Proposed Physician:

Submit electronic comments on this Physician regulation to:

or

Follow the instructions under the “Comment Now” tab. Reference Rule CMS-1715-P.

 



New Jersey Society of Interventional Pain Physicians

NJSIPP News

July 21, 2015 - Governor Christie Signs New Requirements for the Prescription Monitoring Program

May 12, 2015 NJ State Legislative Update

 

 


 

 
 
 
 

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