CMS proposed authorization for facet procedures

[Ronin1]

Just got a heads up that CMS is proposing adding all facet interventions 64490-95, 64633-36 to list of procedures requiring authorization as of 3/1/23. Hassle factor going up some more

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[Analgesia108]

Ever changing guidelines, audits, now auths...death of IPM by a thousand cuts...?

 

[buddababa]

Just got a heads up that CMS is proposing adding all facet interventions 64490-95, 64633-36 to list of procedures requiring authorization as of 3/1/23. Hassle factor going up some more

maybe its time to become an opioid only clinic - this budget neutral crap is making me mad,

 

[DOctorJay]

maybe its time to become an opioid only clinic - this budget neutral crap is making me mad,

“Budget neutral” is a diversion tactic. Facility fees increase every year.

 

[Sig123]

It looks like this is for the hospital outpatient only (similar to what they did for Botox in this setting):

CMS proposes to add Facet Joint Interventions as a new service category subject to the Hospital Outpatient Prior Authorization Process on or after March 1, 2023. For CY 2020, CMS finalized a policy whereby hospitals must seek provisional affirmation of coverage before select outpatient services are furnished to beneficiaries and before a claim can be submitted for processing. This prior authorization requirement applied initially to only five categories of services: blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty and vein ablation

 

[myrandom2003]

How do you even get an authorization for Medicare?

 

[buddababa]

How do you even get an authorization for Medicare?

the same way we do now for scs, there's a portal

 

[Multimodal]

I wonder if this will reduce clawbacks from RAC audits if they have to review for medical necessity first.

 

[drpainfree]

the same way we do now for scs, there's a portal

what portal?