On January 1, 2020, the new reimbursement codes from Centers for Medicare and Medicaid Services (CMS) went into effect and one of the most anticipated of the new codes was the updated surgeon payment reimbursement amount associated with minimally invasive sacroiliac (SI) joint fusion procedures.
In an uncharacteristically (for CMS) generous move, the new codes for SI joint fusions were effectively increased 27% by way of a recalculation in Work Relative Value Units (RVU) associated with CPT code 27279. CMS increased the value units from 9.03 to 12.13 which had the effect of raising surgeon payments for the SI bone fusion procedure from $720 to $915 (27% increase).
“Since the FDA cleared iFuse, more than 40,000 procedures have been performed by 1,900 surgeons, helping patients with SI joint dysfunction experience significantly less pain and improved quality of life,” said Jeffrey Dunn, president, CEO and chairman at SI-BONE, Inc. “We applaud this decision by CMS to increase the physician fee for CPT 27279 based on the greater work effort and intensity involved when performing these minimally invasive SI joint fusion procedures.”
Asked to what extent SI BONE worked with CMS on the Medicare Physician Fee Schedule for CPT Code 27279, Dunn told OTW, “Multiple surgeons, led by ISASS [International Society for the Advancement of Spine Surgery] in particular, engaged with CMS to correct the CPT 27279 physician fee payment. There were numerous meetings over the past year and a half to review the published clinical evidence, surgeon work input, as well as CMS utilization data on MIS SI joint fusion. [SI-BONE supported these efforts with data from its clinical trials and other clinico-economic analyses.]”
As for the rationale for the increase from 9.03 to 12.13, he noted, “Originally, the payment for minimally invasive sacroiliac joint fusion surgery was cross-walked from a percutaneous disc decompression procedure, which is a needle-based procedure, rather than an ‘MIS’ surgery more comparable to MIS SI joint fusion.
Needle-based procedures are typically very different from surgeries with respect to work effort, time and intensity. After review of the published clinical data, including three prospective multi-center clinical trials, numerous published survey results papers, and comments submitted directly to CMS by more than 80 surgeons, CMS determined that the Work RVUs previously assigned to MIS SI joint fusion was not appropriate based on its physician time and work intensity, and compared to other more similar procedures.”
“CMS raised the Work RVUs for MIS SI joint fusion, and together with other RVU adjustments for CY 2020, resulted in a 27% increase. We believe that this will better align payment with work effort, so that surgeons will be paid more appropriately for performing MIS SI joint fusion.”
