Comparison of Relative Value Units and Reimbursements for Spine Procedures under the 2016 Physician Fee Schedule Final Rule vs. the 2017 Final Rule

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Bartholomew Norton
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1 Comparison of Relative Value Units and Reimbursements for Spine Procedures under the 2016 Physician Fee Schedule Rule vs. the Rule CPT Code/ HCPCS 2016 Work Work 2016 Facility Practice Expense Facility Practice Expense 2016 Mal- Practice Malpractice 2016 Total Facility Total Facility Reimburse- Difference in Reimbursement from 2016 to 2016 Reimburse- Description 1 ment 2 ment Sp bone algrft morsel add-on $0.00 $0.00 $ Sp bone algrft struct add-on $ $ $ Sp bone agrft local add-on $0.00 $0.00 $ Sp bone agrft morsel add-on $ $ $ Sp bone agrft struct add-on $ $ $ I&d p-spine c/t/cerv-thor $ $ $ I&d abscess p-spine l/s/ls $ $ $ Remove part of neck vertebra $ $ $ Remove part thorax vertebra $ $ $ Remove part lumbar vertebra $ $ $ Remove extra spine segment $ $ $ Remove part of neck vertebra $1, $1, $ Remove part thorax vertebra $1, $1, $ Remove part lumbar vertebra $1, $1, $ Remove extra spine segment $ $ $ Incis spine 3 column thorac $2, $2, $ Incis spine 3 column lumbar $2, $2, $ Incis spine 3 column adl seg $ $ $ Incis 1 vertebral seg cerv $1, $1, $ Incis 1 vertebral seg thorac $1, $1, $ Incis 1 vertebral seg lumbar $1, $1, $ Incis addl spine segment $ $ $ Incis w/discectomy cervical $1, $1, $ Incis w/discectomy thoracic $1, $1, $ Incis w/discectomy lumbar $1, $1, $ Revise extra spine segment $ $ $ Closed tx spine process fx 2.13 Deleted 2.46 Deleted 0.40 Deleted 4.99 Deleted $ Deleted Deleted Closed tx vert fx w/o manj $ $ $ Closed tx vert fx w/manj $ $ $1.34

2 22318 Treat odontoid fx w/o graft $1, $1, $ Treat odontoid fx w/graft $1, $1, $ Treat spine fracture $1, $1, $ Treat neck spine fracture $1, $1, $ Treat thorax spine fracture $1, $1, $ Treat each add spine fx $ $ $ Manipulation of spine $ $ $ Perq cervicothoracic inject $ $ $ Perq lumbosacral injection $ $ $ Vertebroplasty addl inject $ $ $ Perq vertebral augmentation $ $ $ Perq vertebral augmentation $ $ $ Perq vertebral augmentation $ $ $ Idet single level $ $ $ Idet 1 or more levels $ $ $ Lat thorax spine fusion $1, $1, $ Lat lumbar spine fusion $1, $1, $ Lat thor/lumb addl seg $ $ $ Neck spine fusion $2, $2, $ Neck spine fuse&remov bel c $1, $1, $ Addl neck spine fusion $ $ $ Neck spine fusion $1, $1, $ Thorax spine fusion $1, $1, $ Lumbar spine fusion $1, $1, $ Additional spinal fusion $ $ $ Prescrl fuse w/ instr l5-s $1, $1, $ Spine & skull spinal fusion $1, $1, $ Neck spinal fusion $1, $1, $ Neck spine fusion $1, $1, $ Thorax spine fusion $1, $1, $ Lumbar spine fusion $1, $1, $ Spine fusion extra segment $ $ $ Lumbar spine fusion $1, $1, $ Spine fusion extra segment $ $ $ Lumbar spine fusion combined $1, $1, $ Spine fusion extra segment $ $ $ Post fusion </6 vert seg $1, $1, $ Post fusion 7-12 vert seg $2, $2, $10.52

3 22804 Post fusion 13/> vert seg $2, $2, $ Ant fusion 2-3 vert seg $1, $1, $ Ant fusion 4-7 vert seg $2, $2, $ Ant fusion 8/> vert seg $2, $2, $ Kyphectomy 1-2 segments $2, $2, $ Kyphectomy 3 or more $2, $2, $ Exploration of spinal fusion $ $ $ Insert spine fixation device $ $ $ Insert spine fixation device $0.00 $0.00 $ Insert spine fixation device $ $ $ Insert spine fixation device $ $ $ Insert spine fixation device $1, $1, $ Insert spine fixation device $ $ $ Insert spine fixation device $ $ $ Insert spine fixation device $ $ $ Insert pelv fixation device $ $ $ Reinsert spinal fixation $1, $1, $ Remove spine fixation device $ $ $ Apply spine prosth device 6.70 Deleted 3.23 Deleted 1.64 Deleted Deleted $ Deleted Deleted Remove spine fixation device $ $ $ Insj biomechanical device New 4.25 New 2.03 New 1.36 New 7.64 New $ New Code Insj biomechanical device New 5.50 New 2.63 New 1.76 New 9.89 New $ New Code Remove spine fixation device $1, $1, $ Cerv artific diskectomy $1, $1, $ Lumbar artif diskectomy $2, $1, $ Second level cer diskectomy $ $ $ Insj biomechanical device New 5.50 New 2.63 New 1.76 New 9.89 New $ New Code Revise cerv artific disc $2, $2, $ Revise lumbar artif disc $2, $2, $ Remove cerv artif disc $2, $2, $ Remove lumb artif disc $2, $2, $ Insj stablj dev w/dcmprn New New New 4.27 New New $1, New Code Insj stablj dev w/dcmprn New 4.00 New 1.92 New 1.22 New 7.14 New $ New Code Insj stablj dev w/o dcmprn New 7.03 New 6.71 New 1.96 New New $ New Code Insj stablj dev w/o dcmprn New 2.34 New 1.13 New 0.69 New 4.16 New $ New Code Spine surgery procedure $0.00 $0.00 $ Arthrodesis sacroiliac joint $ $ $ Fusion of sacroiliac joint $1, $1, $0.61

4 62263 Epidural lysis mult sessions $ $ $ Epidural lysis on single day $ $ $ Interdiscal perq aspir dx $ $ $ Drain spinal cord cyst $ $ $ Needle biopsy spinal cord $ $ $ Spinal fluid tap diagnostic $80.56 $80.75 $ Drain cerebro spinal fluid $87.00 $87.21 $ Inject epidural patch $ $ $ Treat spinal cord lesion $ $ $ Treat spinal cord lesion $ $ $ Treat spinal canal lesion $ $ $ Injection for myelogram $88.79 $90.80 $ Percutaneous diskectomy $ $ $ Inject for spine disk x-ray $ $ $ Inject for spine disk x-ray $ $ $ Injection into disk lesion $ $ $ Injection into spinal artery $ $ $ Myelography lumbar injection $ $ $ Myelography lumbar injection $ $ $ Myelography lumbar injection $ $ $ Myelography lumbar injection $ $ $ Inject spine cerv/thoracic 1.91 Deleted 1.09 Deleted 0.16 Deleted 3.16 Deleted $ Deleted Deleted Inject spine lumbar/sacral 1.54 Deleted 0.92 Deleted 0.14 Deleted 2.60 Deleted $93.09 Deleted Deleted Inject spine w/cath crv/thrc 2.04 Deleted 0.72 Deleted 0.16 Deleted 2.92 Deleted $ Deleted Deleted Inject spine w/cath lmb/scrl 1.87 Deleted 0.78 Deleted 0.16 Deleted 2.81 Deleted $ Deleted Deleted Njx interlaminar crv/thrc New 1.80 New 0.92 New 0.22 New 2.94 New $ New Code Njx interlaminar crv/thrc New 1.95 New 0.98 New 0.24 New 3.17 New $ New Code Njx interlaminar lmbr/sac New 1.55 New 0.80 New 0.18 New 2.53 New $90.80 New Code Njx interlaminar lmbr/sac New 1.80 New 0.89 New 0.20 New 2.89 New $ New Code Njx interlaminar crv/thrc New 1.89 New 0.55 New 0.24 New 2.68 New $96.18 New Code Njx interlaminar crv/thrc New 2.20 New 0.60 New 0.28 New 3.08 New $ New Code Njx interlaminar lmbr/sac New 1.78 New 0.64 New 0.21 New 2.63 New $94.39 New Code Njx interlaminar lmbr/sac New 1.90 New 0.67 New 0.23 New 2.80 New $ New Code Implant spinal canal cath $ $ $ Implant spinal canal cath $ $ $ Remove spinal canal catheter $ $ $ Insert spine infusion device $ $ $ Implant spine infusion pump $ $ $62.62

5 62362 Implant spine infusion pump $ $ $ Remove spine infusion device $ $ $ Analyze spine infus pump $26.50 $ $ Analyze sp inf pump w/reprog $36.52 $ $ Anal sp inf pmp w/reprg&fill $37.24 $ $ Anl sp inf pmp w/mdreprg&fil $48.69 $ $ Ndsc dcmprn 1 ntrspc lumbar New 0.00 New 0.00 New 0.00 New 0.00 New $0.00 New Code Remove spine lamina 1/2 crvl $1, $1, $ Remove spine lamina 1/2 thrc $1, $1, $ Remove spine lamina 1/2 lmbr $1, $1, $ Remove spine lamina 1/2 scrl $1, $1, $ Remove lamina/facets lumbar $1, $1, $ Remove spine lamina >2 crvcl $1, $1, $ Remove spine lamina >2 thrc $1, $1, $ Remove spine lamina >2 lmbr $1, $1, $ Neck spine disk surgery $1, $1, $ Low back disk surgery $1, $1, $ Spinal disk surgery add-on $ $ $ Laminotomy single cervical $1, $1, $ Laminotomy single lumbar $1, $1, $ Laminotomy addl cervical $0.00 $0.00 $ Laminotomy addl lumbar $0.00 $0.00 $ Remove spine lamina 1 crvl $1, $1, $ Remove spine lamina 1 thrc $1, $1, $ Remove spine lamina 1 lmbr $1, $1, $ Remove spinal lamina add-on $ $ $ Cervical laminoplsty 2/> seg $1, $1, $ C-laminoplasty w/graft/plate $1, $1, $ Decompress spinal cord thrc $1, $1, $ Decompress spinal cord lmbr $1, $1, $ Decompress spine cord add-on $ $ $ Decompress spinal cord thrc $1, $1, $ Decompress spine cord add-on $ $ $ Neck spine disk surgery $1, $1, $ Neck spine disk surgery $ $ $ Spine disk surgery thorax $1, $1, $ Spine disk surgery thorax $ $ $ Remove vert body dcmprn crvl $1, $1, $4.32

6 63082 Remove vertebral body add-on $ $ $ Remove vert body dcmprn thrc $2, $2, $ Remove vertebral body add-on $ $ $ Remov vertbr dcmprn thrclmbr $2, $2, $ Remove vertebral body add-on $ $ $ Remove vert body dcmprn lmbr $2, $2, $ Remove vertebral body add-on $ $ $ Remove vert body dcmprn thrc $2, $2, $ Remove vert body dcmprn lmbr $2, $2, $ Remove vertebral body add-on $ $ $ Incise spinal cord tract(s) $1, $1, $ Drainage of spinal cyst $1, $1, $ Drainage of spinal cyst $1, $1, $ Revise spinal cord ligaments $1, $1, $ Revise spinal cord ligaments $1, $1, $ Incise spine nrv half segmnt $1, $1, $ Incise spine nrv >2 segmnts $1, $1, $ Incise spine accessory nerve $1, $1, $ Incise spine & cord cervical $1, $1, $ Incise spine & cord thoracic $1, $1, $ Incise spine&cord 2 trx crvl $1, $1, $ Incise spine&cord 2 trx thrc $1, $1, $ Incise spin&cord 2 stgs crvl $1, $1, $ Incise spin&cord 2 stgs thrc $1, $1, $ Release spinal cord lumbar $1, $1, $ Revise spinal cord vsls crvl $2, $3, $ Revise spinal cord vsls thrc $3, $3, $ Revise spine cord vsl thrlmb $3, $3, $ Excise intraspinl lesion crv $1, $1, $ Excise intrspinl lesion thrc $1, $1, $ Excise intrspinl lesion lmbr $1, $1, $ Excise intrspinl lesion scrl $1, $1, $ Excise intrspinl lesion crvl $2, $2, $ Excise intrspinl lesion thrc $2, $2, $ Excise intrspinl lesion lmbr $1, $1, $ Excise intrspinl lesion scrl $1, $1, $ Bx/exc xdrl spine lesn crvl $1, $1, $ Bx/exc xdrl spine lesn thrc $1, $1, $8.00

7 63277 Bx/exc xdrl spine lesn lmbr $1, $1, $ Bx/exc xdrl spine lesn scrl $1, $1, $ Bx/exc idrl spine lesn crvl $2, $2, $ Bx/exc idrl spine lesn thrc $2, $2, $ Bx/exc idrl spine lesn lmbr $2, $2, $ Bx/exc idrl spine lesn scrl $1, $1, $ Bx/exc idrl imed lesn cervl $2, $2, $ Bx/exc idrl imed lesn thrc $2, $2, $ Bx/exc idrl imed lesn thrlmb $2, $2, $ Bx/exc xdrl/idrl lsn any lvl $2, $2, $ Repair laminectomy defect $ $ $ Remove vert xdrl body crvcl $1, $1, $ Remove vert xdrl body thrc $2, $2, $ Remove vert xdrl body thrlmb $2, $2, $ Remov vert xdrl bdy lmbr/sac $2, $2, $ Remove vert idrl body crvcl $2, $2, $ Remove vert idrl body thrc $2, $2, $ Remov vert idrl bdy thrclmbr $2, $2, $ Remov vert idrl bdy lmbr/sac $2, $2, $ Remove vertebral body add-on $ $ $ Remove spinal cord lesion $ $ $ Stimulation of spinal cord $ $ $ Remove lesion of spinal cord $1, $1, $ Srs spinal lesion $1, $1, $ Srs spinal lesion addl $ $ $ Implant neuroelectrodes $ $ $ Implant neuroelectrodes $ $ $ Remove spine eltrd perq aray $ $ $ Remove spine eltrd plate $ $ $ Revise spine eltrd perq aray $ $ $ Revise spine eltrd plate $ $ $ Insrt/redo spine n generator $ $ $ Revise/remove neuroreceiver $ $ $ Repair of spinal herniation $1, $1, $ Repair of spinal herniation $1, $1, $ Repair of spinal herniation $1, $1, $ Repair of spinal herniation $1, $1, $ Repair spinal fluid leakage $ $ $0.25

8 63709 Repair spinal fluid leakage $1, $1, $ Graft repair of spine defect $1, $1, $ Install spinal shunt $ $ $ Install spinal shunt $ $ $ Revision of spinal shunt $ $ $ Removal of spinal shunt $ $ $ Total Facility = Work + Facility Practice Expense + Malpractice Reimbursement is calculated using a conversion factor of $ Reimbursement is calculated using a conversion factor of $ Reimbursement = [(Work x GPCI) + (Facility Practice Expense x GPCI) + (Malpractice x GPCI)] x Conversion Factor Please note that the reimbursement amounts contained in this spreadsheet are not calculated using the geographic practice cost indices (GPCI), so your reimbursement will be slightly different than the amounts listed based on the geographic location of your practice. CPT codes and descriptions are copyright of the American Medical Association. All Rights Reserved.

Comparison of Relative Value Units and Reimbursements for Spine Procedures under the 2016 Physician Fee Schedule Final Rule vs. the 2017 Proposed Rule

Comparison of Relative Value Units and Reimbursements for Spine Procedures under the 2016 Physician Fee Schedule Final Rule vs. the Rule CPT Code/ HCPCS 2016 Final Work Work 2016 Final Facility Practice