On April 11, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2026 Inpatient Prospective Payment System (IPPS) proposed rule. Comments are due on June 10. Highlights of key provisions of interest to neurosurgeons are below:
Payment Provisions
Changes to Specific MS-DRGs
- Spinal Fusion: CMS received a request to adjust the methodology for assigning MS-DRGs for certain spinal fusion cases “with an ICD-10 PCS code that describes fusion of a sacroiliac joint using an internal fixation device with tulip connector or insertion of an internal fixation device with tulip connector into a pelvic bone with another spinal fusion procedure code.” CMS declined to make changes because these MS-DRGs are new and the agency is continuing to analyze payment data.
- Bone Void Filler: CMS received a request for adjustments to the methodology for assigning MS-DRGs for procedures with ICD-10 XW0V0P7 (Introduction of antibiotic-eluting bone void filler into bones, open approach, new technology group 7). CMS declined to make changes this year in favor of further review.
- Neurostimulator and Chemotherapy Implants: CMS again received a number of requests related to the MS-DRGs that describe craniotomy and endovascular procedures. CMS proposes the following changes:
- Chemotherapy Implants: CMS agreed to reassign certain cases describing chemotherapy implants to MS-DRG 023 (Craniotomy with Major Device Implant or Acute Complex CNS Principal Diagnosis with MCC or Chemotherapy Implant or Epilepsy with Neurostimulator) and MS-DRG 024 (Craniotomy with Major Device Implant or Acute Complex CNS Principal Diagnosis without MCC)
- Neurostimulator Implants: CMS is proposing to reassign procedure code combinations that describe (1) the insertion of multiple or single array neurostimulator generators with the insertion of a neurostimulator lead into the brain or the cerebral ventricle; and (2) the insertion of a neurostimulator generator inserted into the skull with the insertion of a neurostimulator lead into the brain. These cases would go into revised MS-DRGs 020, 021, and 022 that would have the following revised descriptors:
- MS-DRG 020 (Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage or Intracranial Neurostimulator Implant with MCC)
- MS-DRG 021 (Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage or Intracranial Neurostimulator Implant with CC)
- MS-DRG 021 (Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage or Intracranial Neurostimulator Implant with CC)
- MS-DRG 021 (Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage or Intracranial Neurostimulator Implant with CC)
- MS-DRG 022 (Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage or Intracranial Neurostimulator Implant without CC/MCC)
- New technology: Add-on Payment Applications.
- CMS proposes to approve, and seeks comment, on the following new technology add-on payment (NTAP) applications under the alternative pathway: aprevo®-C Cervical Interbody Fusion Device, EUROPA™ Posterior Cervical Fusion System, iFuse TORQ TNT™ Implant System, PearlMatrix P-15 Peptide Enhanced Bone Graft.
