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Medicare Requires Prior Authorization for Spine Procedures

Over the strenuous objection of the AANS, the CNS and other health care stakeholders, effective July 1, the Centers for Medicare & Medicaid Services (CMS) now requires prior authorization for cervical spinal fusion (CPT® codes 22551 and 22552) and implanted spinal neurostimulator procedures (CPT code 63650) when performed in the hospital outpatient department. Neurosurgeons may submit the prior authorization request to their Medicare Administrative Contractors (MACs) by mail, fax, CMS Electronic Submission of Medical Documentation or the MAC’s portal. The MAC must respond to the prior authorization request within 10 days. However, an expedited response may be granted within two days if the provider makes the case that a delay could jeopardize the beneficiary’s life, health or ability to regain maximum function.

More information is available as follows:

  • Click here for the program overview;
  • Click here for detailed guidance from CMS;
  • Click here for answers to frequently asked questions; and
  • Click here to find your MAC for additional details about the new requirements.