IPSIS is committed to promoting accurate coding and appropriate reimbursement for interventional spine procedures.
- Medicare to Partially Offset Previous Cuts (March 20, 2024)
- Coding & Reimbursement FAQs (March 19, 2024)
- Navigating the Cyberattack on Change Healthcare (March 8, 2024)
- IPSIS Urges Noridian to Revise ESI Documentation Requirements (January 26, 2024)
- IPSIS Secures Clearer Medicare ESI Doc Requirements (December 6, 2023)
- Medicare Fee Schedule Highlights (November 4, 2023)
- Top Reasons for Prior Authorization Outpatient Department Rejections (July 24, 2023)🔒
- Cigna Modifier 25 Policy Update (May 25, 2023)
- Opposing Cigna Modifier 25 Policy (April 24, 2023)
- Facet Joint Intervention Payment Clawback (March 30, 2023)
- Incorrect Coding and Documentation Errors for CPT code 63685 (January 12, 2023)
- NGS Adjusting Claims for RFA Services (November 2, 2022)
- Resources for Proper Payment and Appeals (October 28, 2022)
- FAQ on the Current Local Coverage Determination on Epidural Steroid Injections for Pain Management (January 19, 2022) 🔒
- New ICD-10 Code for Vertebrogenic Low Back Pain (October 19, 2021)
- IPSIS Joins AMA-Led Effort to Promote Use of CPT Code Set for Data Exchange Standards (August 30, 2021)
- FAQ on the 2021 Local Coverage Determination on Facet Joint Interventions for Pain Management (June 28, 2021) 🔒
- OIG to Audit Medicare Payments for Spinal Pain Management Services (June 4, 2021)
- IPSIS Provides Important Guidance for Interventional Pain Physicians on New CPT® E/M Codes (January 14, 2021)
- Coding/Coverage Corner: Amniotic or Umbilical Cord Tissue Products (November 16, 2020)
- New for 2020: Sacroiliac Joint and Genicular Nerve Procedure Codes (January 7, 2020) 🔒
Perplexed about coding requirements?
Confused about how to code your practice's procedures?
IPSIS members submit your questions here 🔒 to receive expert coding advice.
Looking for practical solutions to common coding challenges? Visit the Coding and Reimbursement FAQ 🔒.
CPT/RUC Process
For many years, the International Pain and Spine Intervention Society has had an actively participating representative and professional staff at all RUC and CPT meetings. The Society is the only interventional pain organization with consistent
participation and volunteers and staff at each meeting.
RUC
The Resource-Based Relative Value Scale (RBRVS) Update Committee (RUC) is an advisory body to the Centers for Medicare and Medicaid Services charged with recommending relative value units (RVUs) that determine the reimbursement level for each
CPT code. The RUC assesses the resource costs needed to provide specific services, broken down by physician work, practice expense, and professional liability insurance. Payments are calculated using a conversion factor, determined by CMS.
More information can be obtained HERE.
CPT
The CPT Editorial Panel is in charge of the development and revisions of Current Procedural Terminology procedure codes. More information can be obtained HERE.
- Wesley R. Ibazebo, MD, Represents IPSIS at the April 2024 Chicago AMA RUC Meeting (April 29, 2024)
- Wesley R. Ibazebo, MD, Represents IPSIS at the September 2023 Chicago AMA RUC Meeting (September 29, 2023)
- IPSIS Represented at April 2023 San Diego AMA RUC Meeting (April 29, 2023)
- IPSIS Represented at AMA Current Procedural Terminology Editorial Panel Meeting (February 14, 2023)
- Wesley R. Ibazebo, MD, Represents IPSIS at AMA RUC Meeting (January 12, 2023)
- IPSIS Represented at the February 2022 CPT Meeting by Dr. Scott Horn (February 14, 2022)
- Drs. Wesley Ibazebo and Graham Wagner Represent IPSIS at January AMA RUC Meeting (February 14, 2022)
- Drs. W. David Mauck and Kate Sully Represent IPSIS at November AMA House of Delegates Meeting (November 11, 2021)
- Drs. Wesley Ibazebo and Graham Wagner Represent IPSIS at October AMA RUC Meeting (October 19, 2021)
- IPSIS Represented at the September 2021 CPT Meeting by Dr. Scott Horn (October 19, 2021)
- IPSIS Members Represented at Virtual AMA House of Delegates Special Meeting (June 16, 2021)
- Dr. Scott Horn Represented IPSIS at the May 2021 CPT Meeting (May 18, 2021)
- Drs. Wesley Ibazebo and Graham Wagner are representing IPSIS at the 4/21 - 4/24 Virtual RUC Meeting (April 21, 2021)
- Scott Horn, DO Represented IPSIS at the February 2021 CPT Meeting (February 16, 2021)
- IPSIS Represented at AMA RUC Meeting (January 14, 2021)
- IPSIS Represented at October 2020 Virtual CPT and RUC Meetings (October 20, 2020)
- IPSIS Members Represented at AMA CPT Editorial Panel Meeting (June 16, 2020)
- IPSIS Members Represented at AMA CPT Editorial Panel Meeting (February 10, 2020)
- Dr. Wesley R. Ibazebo Representing IPSIS at This Week’s AMA RUC Meeting (January 17, 2020)
- Facet LCD Comments (April 1, 2024)
- Help Reverse Payment Cuts (March 6, 2024)
- IPSIS Seeks Clarity on ESI Requirements from Medicare (October 12, 2023)
- Support Payment Reform: Take Action Now: Deadline July 12, 2023 (July 3, 2023)
- Support Payment Reform: Take Action Now (June 16, 2023)
- Support Prior Authorization Reform (June 01, 2023)
- ALERT: Act Now to Support Medicare Payment Rates Tied to Inflation (April 14, 2023)
- Congress Must Reform Medicare Physician Payment by End of 2022 (September 29, 2022)
- IPSIS Seeks Extension of the Moratorium on Medicare Sequester Cuts While the COVID Pandemic Persists (February 16, 2020)
- IPSIS Joins AMA and Others in Expressing Concern to HHS Regarding E&M Budget Neutrality (July 9, 2020)
- IPSIS Seeks Information from AMGA on Valuations for Interventional Pain Management Services (May 26, 2020)
- IPSIS, AMA, and Physician Organizations Urge Additional COVID-19 Legislative Action (April 16, 2020)
- IPSIS Supports Balanced Legislation to Protect Patients from Surprise Billing (October 23, 2019)
The Centers for Medicare & Medicaid Services (CMS) makes decisions regarding providers and patients on regulatory and reimbursement issues that impact all members of the International Pain and Spine Intervention Society (IPSIS). The Health
Policy Division actively monitors CMS coding, coverage, and reimbursement policy related to interventional pain management practice. IPSIS provides feedback to CMS on regulatory and reimbursement issues via comment letters and attendance at
meetings.
For additional resources, see:
- Medicare Physician Fee Schedule Comments (September 14, 2024)
- Comments on Proposed 2024 Medicare Fee Schedule (September 18, 2023)
- Medicare Advantage and Prior Authorization Improvements (April 11, 2023)
- IPSIS Advocates for Higher Reimbursement of Pain Interventions (September 13, 2021)
- IPSIS and Others Welcome New CMMI Director and Recommend Alternative Payment Model Improvements (May 25, 2021)
- IPSIS and Others Seek More Timely and Higher Quality MIPS Benchmarks (April 15, 2021)
- IPSIS Recommends Changes to Merit-based Incentive Payment System Value Pathways (March 11, 2021)
- IPSIS Opposes Multiple Proposed Radical Revisions to Medicare Payment Policies (October 7, 2020)
- IPSIS, AMA, and Many Other Medical Organizations Recommend CMS Revamp MIPS Value Pathway (April 13, 2020)
- IPSIS, AMA and Many Other Medical Organizations Urge CMS to Rethink Quality Reporting Policies (February 4, 2020)
- AMA Urges CMS to Improve and Clarify Imaging Appropriate Use Program (January 14, 2020)
- IPSIS Advises CMS on Proper Place-of-Service Classification for New Code for Genicular RFA (December 2, 2019)
- IPSIS Finds CMS Prematurely Proposing Changes to Office Visit E/M Codes, Suggests Specific Valuations (October 14, 2019)
- IPSIS, AMA, and Over 100 Other Stakeholders Advise CMS on How to Simplify Prior Authorization (October 10, 2019)
- IPSIS Urges CMS to Correct the Ambulatory Payment Classification for Genicular Nerve Ablation (October 1, 2019)
- IPSIS Supports U.S. House Bill to Protect Patients from Delayed Care by Streamlining Prior Authorization (September 16, 2019)
- CMS Proposes Valuation of Interventional Procedures – IPSIS Will Promote Appropriate Reimbursement (August 7, 2019)
- IPSIS and Many Others Urge CMS to Provide Prior Authorization Guidance to Medicare Advantage Plans (March 6, 2019)
2024
- Final 2025 Medicare Physician Fee Schedule Highlights (November 7, 2024)
- 2025 Medicare Fee Schedule Analysis (July 12, 2024)
2023
- Medicare Fee Schedule Highlights (November 4, 2023)
- CMS Posts Program Year 2022 Open Payments Data (August 8, 2023)
- Preliminary Analysis: Medicare Physician Fee Schedule (July 14, 2023)
2022
- CMS Releases CY 2023 Proposed Medicare Physician Fee Schedule (July 15, 2022)
2020
- MIPS Exception Deadline Extended (December 10, 2020)
- CMS Provides Additional Guidance to Healthcare Providers on Quality Payment Program COVID-19 Relief (March 30, 2020)
- In Response to COVID-19, CMS Grants Relief for Those Participating in Quality Reporting Programs (March 23, 2020)
- New for 2020: Sacroiliac Joint and Genicular Nerve Procedure Codes (January 7, 2020) 🔒
The Medicare Administrative Contractors (MAC) process claims for Medicare beneficiaries. Contractors are responsible for specific geographic jurisdictions, as listed below. For more information, click HERE.
CGS Administrators, LLC
- MAC Jurisdiction DME C-Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Puerto Rico, U.S. Virgin Islands
- MAC Jurisdiction 15-Kentucky, Ohio
National Government Services, Inc. (NGS)
- MAC Jurisdiction DME B - Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin
- MAC Jurisdiction 6 - Illinois, Minnesota, Wisconsin
- MAC Jurisdiction K - Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont
National Government Services, Inc. (NGS)
- MAC Jurisdiction DME D-Alaska, Arizona, California, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming, American Samoa, Guam, Northern Mariana Islands
- MAC Jurisdiction E-California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands
- MAC Jurisdiction F-Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming
Cahaba Government Benefit Admin
- MAC Jurisdiction 10-Alabama, Georgia, Tennessee
First Coast Service Options, Inc
- MAC Jurisdiction N-Florida, Puerto Rico, U.S. Virgin Islands
Novitas Solutions, Inc.
- MAC Jurisdiction H-Arkansas, Colorado, New Mexico, Oklahoma, Texas, Louisiana, Mississippi
- MAC Jurisdiction L-Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania (includes Part B for counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia)
Palmetto GBA, LLC
- MAC Jurisdiction 11-North Carolina, South Carolina, Virginia, West Virginia (excludes Part B for the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia)
Wisconsin Physicians Service Insurance Corporation
- MAC Jurisdiction 5-Iowa, Kansas, Missouri, Nebraska
- MAC Jurisdiction 8-Indiana, Michigan
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