CMS released the 2021 proposed payment rule for hospital outpatient departments and ASCs on Aug. 4.
The agency proposed removing 300 musculoskeletal procedure codes from the inpatient-only list over a three-year period, including 67 spine codes for 2021.
Below are the spine procedures CMS may remove from the inpatient-only list next year.
1. Removal of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (list separately in addition to code for primary procedure): 0095T
2. Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (list separately in addition to code for primary procedure): 0095T
3. Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), each additional interspace, lumbar (list separately in addition to code for primary procedure): 0163T
4. Removal of total disc arthroplasty, (artificial disc), anterior approach, each additional interspace, lumbar (list separately in addition to code for primary procedure): 0163T
5. Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, lumbar (list separately in addition to code for primary procedure): 0165T
6. Posterior vertebral joint(s) arthroplasty (for example, facet joint[s] replacement), including facetectomy, laminectomy, foraminotomy, and vertebral column fixation, injection of bone cement, when performed, including fluoroscopy, single level, lumbar spine: 0202T
7. Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; cervical: 0219T
8. Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; thoracic: 0219T
9. Application of halo, including removal; cranial: 20661
10. Application of halo, including removal, cranial, 6 or more pins placed, for thin skull osteology (for example, pediatric patients, hydrocephalus, osteogenesis imperfecta): 20664
11. Incision and drainage, open, of deep abscess (subfascial), posterior spine; lumbar, sacral, or lumbosacral: 22015
12. Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; cervical: 22110
13. Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; thoracic: 22112
14. Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; lumbar: 22114
15. Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; each additional vertebral segment (list separately in addition to code for primary procedure): 22116
16. Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (for example, pedicle/vertebral body subtraction); thoracic: 22206
17. Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (for example, pedicle/vertebral body subtraction); lumbar: 22207
18. Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (for example, pedicle/vertebral body subtraction); each additional vertebral segment (list separately in addition to code for primary procedure): 22208
19. Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; cervical: 22210
20. Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracic: 22212
21. Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar: 22214
22. Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (list separately in addition to primary procedure): 22216
23. Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervical: 22220
24. Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracic: 22222
25. Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbar: 22224
26. Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (list separately in addition to code for primary procedure): 22226
27. Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar: 22325
28. Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical: 22326
29. Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; thoracic: 22327
30. Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; each additional fractured vertebra or dislocated segment (list separately in addition to code for primary procedure): 22328
31. Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic: 22532
32. Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar: 22533
33. Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional vertebral segment (list separately in addition to code for primary procedure): 22534
34. Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic: 22556
35. Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar: 22558
36. Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, l5-s1 interspace: 22586
37. Arthrodesis, posterior technique, craniocervical (occiput-c2): 22590
38. Arthrodesis, posterior technique, atlas-axis (c1-c2): 22595
39. Arthrodesis, posterior or posterolateral technique, single level; cervical below c2 segment: 22600
40. Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed): 22610
41. Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar: 22630
42. Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each additional interspace (list separately in addition to code for primary procedure): 22632
43. Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments: 22800
44. Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments: 22802
45. Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments: 22804
46. Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments: 22808
47. Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral segments: 22810
48. Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segments: 22812
49. Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); single or 2 segments: 22818
50. Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); 3 or more segments: 22819
51. Exploration of spinal fusion: 22830
52. Internal spinal fixation by wiring of spinous processes (list separately in addition to code for primary procedure): 22841
53. Posterior segmental instrumentation (for example, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (list separately in addition to code for primary procedure): 22843
54. Posterior segmental instrumentation (for example, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (list separately in addition to code for primary procedure): 22844
55. Anterior instrumentation; 4 to 7 vertebral segments (list separately in addition to code for primary procedure): 22846
56. Anterior instrumentation; 8 or more vertebral segments (list separately in addition to code for primary procedure): 22847
57. Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (list separately in addition to code for primary procedure): 22848
58. Reinsertion of spinal fixation device: 22849
59. Removal of posterior nonsegmental instrumentation (for example, harrington rod): 22850
60. Removal of posterior segmental instrumentation: 22852
61. Removal of anterior instrumentation: 22855
62. Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar: 22857
63. Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical: 22861
64. Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar: 22862
65. Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical: 22864
66. Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical: 22865
67. Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring includes internal fixation, when performed: G0412