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In March, CIGNA released policy 0539, characterizing peripheral nerve stimulation (PNS) as “not medically necessary.” NANS is currently working with the PNS Subcommittee to respond to this categorization.
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NANS joins the Multisociety Pain Workgroup to object to Palmetto’s draft local coverage determination (LCD DL39797) for minimally invasive arthrodesis of the sacroiliac joint. Palmetto is Medicare Administrative Contractor (MAC) with jurisdiction over several states in the Southeast U.S.
In December, NANS led efforts on behalf of the Multisociety Pain Workgroup (MPW) to object to the insurers’ classification of closed-loop spinal cord stimulation (SCS) as “experimental, investigational and/or unproven.” Thanks to these efforts, Cigna and EviCore (and includes several Blue Cross Blue Shield plans) have revised their policies to include coverage of closed-loop SCS. These revised policies become effective May 1, 2024.
In January 2024, Humana issued Medicare Advantage policy HUM-1140-000 [PDF], excluding from coverage peripheral nerve stimulators (PNS) for treating chronic pain. This policy contradicts Medicare's longstanding practice of covering and paying for the reasonable and necessary use of PNS for chronic pain management and appears inconsistent with the Noridian Local Coverage Decision and the CMS National Coverage Decision (NCD 160.7). Working with the Multi-Society Pain Workgroup, NANS issued a statement [PDF] on behalf of 12 medical societies to Humana and CMS administrators objecting to the policy.
Recently, 32 U.S. Senators sent a bipartisan letter to Senate leaders calling for a legislative solution to protect access to Medicare services by canceling the 3.37% cut to physician Medicare payments that went into effect on January 1, 2024.
In January, NANS and other national medical specialty societies and state medical associations strongly urged Congressional leaders to quickly pass legislation to reverse the 3.37% Medicare physician payment cuts that took effect at the beginning of 2024.
Read more in the sign-on letter We previously informed you about a multi-state BCBS draft policy on closed-loop SCS, which ultimately was repealed. This fall, NANS was alerted that several other insurers, including Cigna, eviCore, Excellus, Humana, and UPMC, have adopted policies calling closed-loop SCS "experimental, investigational, and/or unproven."
In October, we alerted you to the advocacy efforts NANS was leading on behalf of 13 medical societies, representing 95,000 physicians, to extend coverage for SCS in Washington State. On Friday, November 17, the State's Health Technology Clinical Committee met to hear from stakeholders on the issue.
On November 2, the Centers for Medicare & Medicaid Services (CMS) released its calendar year 2024 final rule for the physician fee schedule. The rule will cut the conversion factor by 3.4%, to $32.74 in the calendar year (CY) 2024, as compared to $33.89 in CY 2023. This reflects the expiration of the 2.5% statutory payment increase for CY 2023; a 1.25% statutory payment increase for 2024; a 0.00% conversion factor update under the Medicare Access and Children’s Health Insurance Program Reauthorization Act; and a budget-neutrality adjustment.
On Monday, October 3, NANS led a multi-society response to Washington State Health Care Authority (WSHCA) on its review of the evidence for spinal cord stimulation.
Read the response letter here. |
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August 2024
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