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Washington E-Newsletter

Neurosurgery Responds to CMS RFI on Episode-Based Payment Models

In response to a Centers for Medicare & Medicaid Services (CMS) request for information (RFI), the AANS and the CNS provided input on how best to proceed with episode-based payment models. In the letter, the AANS and CNS recommended that in developing episode-based and alternative payment models, CMS should: The AANS and the CNS also joined the Physician Clinical […]
Washington E-Newsletter

GOLD CARD Act Introduced in the House of Representatives

On July 27, Reps. Michael Burgess, MD, (R-Texas) and Vicente Gonzalez (D-Texas) introduced the Getting Over Lengthy Delays in Care As Required by Doctors (GOLD CARD) Act (H.R. 4968). This bipartisan bill would exempt providers from prior authorization requirements in the Medicare Advantage program for one year if at least 90% of prior authorization requests in the preceding […]
Washington E-Newsletter

Neurosurgery Presses Aetna to Modify ACDF Surgery Policy

Despite two decades of scientific literature, Aetna remains the only major commercial insurer that routinely denies coverage for interbody spacers in anterior cervical discectomy and fusion (ACDF). Aetna’s policy deems poly-ether-ether-ketone, or PEEK, and metallic spacers (CPT code 22853) as “experimental and not medically necessary” for routine ACDF. On Aug. 30, the AANS, CNS and AANS/CNS Joint […]
Washington E-Newsletter

Neurosurgery Partners with FDA for Breakthrough Device Innovation

Through its Drugs and Devices Committee, the AANS and the CNS are collaborating with the Food and Drug Administration (FDA) in its Total Product Life Cycle Program (TAP). The TAP pilot program is designed to provide participants with earlier and more frequent interactions with the FDA and more strategic engagement with non-FDA stakeholders to help spur rapid […]
Washington E-Newsletter

Cigna and UnitedHealthcare Reduce Use of Prior Authorization

Following sustained advocacy efforts by neurosurgery and others, UnitedHealthcare recently announced that beginning on Sept. 1, it would start a two-phased approach to eliminate prior authorization for 20% of covered services, including disc arthroplasty (CPT codes 22864 and 22865). The company also said it plans to roll out a “gold card” program next year, eliminating most prior authorization requirements for […]
Washington E-Newsletter

Neurosurgery Mentioned in Article on Carotid Stenting Coverage in Medicare

On July 12, Medscape published an article titled “Expanded Coverage of Carotid Stenting in CMS Draft Proposal,” stating that the Centers for Medicare & Medicaid Services had issued a draft decision memo on carotid-artery stenting (CAS) that would expand Medicare coverage of the procedure and remove certain requirements for CAS facilities and operators. The proposed coverage criteria incorporate recommendations […]
Washington E-Newsletter

AANS and CNS Support Proposed Breakthrough Device Coverage Policy

On Aug. 28, the AANS and the CNS submitted comments to the Centers for Medicare & Medicaid Services responding to a proposal to cover devices cleared under the Food and Drug Administration’s (FDA) Breakthrough Device pathway. The neurosurgery groups expressed support for the new CMS coverage pathway, Transitional Coverage for Emerging Technologies, urging the agency to implement the program […]
Washington E-Newsletter

Neurosurgery Featured in Article about Value-Based Payment Models

On Aug. 28, MedPage Today published an article titled “CMS Facing Challenges Attracting Practices to Value-Based Payment Models.” The article noted that the Centers for Medicare & Medicaid Services (CMS) continues to face numerous challenges in attracting more fee-for-service medical practices to Medicare’s accountable care organizations (ACOs) and other value-based purchasing arrangements. “Since the inception of Medicare value-based care […]
Washington E-Newsletter

AANS and CNS Express Concern about Cigna’s Intraoperative Neuromonitoring Coverage Policy

On June 14, representatives from the AANS and the CNS led a meeting with Cigna medical directors and representatives from the American Academy of Neurology, American Academy of Orthopaedic Surgeons, International Society for the Advancement of Spine Surgery and North American Spine Society to express concerns about Cigna’s intraoperative neuromonitoring (IONM) policy. Previously, the AANS […]
Washington E-Newsletter

Neurosurgery Comments on Proposed 2024 Medicare Physician Fee Schedule

On Sept. 6, the AANS and the CNS submitted comments on the Calendar Year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule. The neurosurgical groups expressed concerns about the 3.5% decrease in the CY 2024 conversion factor, primarily stemming from a new office visit add-on code (G2211) for complex services. In their letter, the AANS and the CNS urged […]