New Analysis Shows Reductions in Spine Surgery Reimbursement

Sarasota, FL (WorkersCompensation.com) – The Centers for Medicare and Medicaid Services (CMS) sets national and state industry standard for pricing for not only Medicare, but commercial and workers compensation as well. As a resource, CMS provides a pricing tool that goes back to the year 2000, and that includes rates and the elements used in calculation of those rates such as conversion factor, relative value units, and practice expense. Additionally, the tool includes payment policy indicators that dictate the percentage of multiple procedure reductions. While different payers and States use the CMS rates in various different ways, such as different percentages multiplied by the CMS rate, payers adhere strictly to the payment policy indicators.  

The reimbursement for spine procedures have fallen drastically over the last 20 years, according to a recent analysis done by researchers from the University of Texas McGovern Medical School. Using the CMS pricing tool, researchers analyzed provider reimbursement for spine procedure codes 22551, 22600, 22633, 63030, and 63047, and instrumentation code 22840, and codes 22842 through 22846. Codes 22551 and 22633 did not exist until 2011 and 2012 were adjusted accordingly in the analysis. 

The researchers found that after adjusting for inflation, reimbursement for anterior cervical discectomy and fusion or code 22551 fell by 11.05 percent with a rate range of $2,009.89 in 2011 to $1,787.85 in 2020. The reimbursement for code 22600 or posterior cervical fusion, decreased 28.38 percent, ranging from $1,889.38 in 2000 to $1,353.14 in 2020. Transforaminal lumbar interbody fusion or code 22633 dropped 7.85 percent going from $2,111.20 in 2012 to $1,945.49 in 2020.

Lower back disc surgery code 63030 saw a 28.17 percent decrease, going from $1,421.78 in 2000 to $1,021.22 in 2020. Code 63047 lumbar laminectomy saw an even larger decrease from $1,700.38 in 2000 to $1,158.25 in 2020, resulting in an overall 31.88 percent reduction. Reimbursement for instrumentation codes have an average decrease as well at 33.43 percent. Average compound annual growth rate was -1.7 percent for the procedure codes, and -2.02 percent for instrumentation codes. 

Overall, the analysts found a “persistent decline in reimbursement rates” for the reimbursement of spine codes. The researchers believe if this reduction is not addressed, continued reduction could eventually result in significant limited access to spinal care. Factoring in that spine surgery carries some highest malpractice premiums, this could very well be foreseeable. 

The results of the study showing a reduction in reimbursement are quite interesting when paired with the fact that the annualized health care spending growth rate in the U.S. is estimated at 2.5 to 3 percent, with back pain accounting for the highest spending category. 

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