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CMS won't delay prior authorizations for outpatient cervical fusions

CMS forged ahead July 1 with a prior authorization requirement for cervical fusion procedures despite protest from several organizations.

The agency revealed in December it planned to require prior authorization for cervical fusion and spinal neurostimulator implantation in hospital outpatient departments after which several professional physician societies, including the American Association of Orthopaedic Surgeons, North American Spine Society and International Society for the Advancement of Spine Surgery, wrote to CMS requesting a delay in implementation.

But in a June 3 letter, Connie Leonard, CMS director of provider compliance, said she would not delay the implementation of the prior authorization policy, explaining that it aims to prevent unnecessary care. CMS intends to send confirmation or denial of service within 10 days of receiving prior authorization requests and speed the process to two days for emergency cases, she said.

Spine surgeons have been critical of the policy change since it was announced.

"Prior authorization is unjustified and unnecessary," Thomas Loftus, MD, of Austin (Texas) Neurosurgical Institute, told Becker's. "Surgeons have trained for many years to make these decisions. They are required to complete extensive annual training to understand current indications for spine surgery. They take an oath to care for patients and are all taught not to offer unnecessary procedures. If Medicare now feels they need to add an additional layer of bureaucracy to providing care, it would indicate that all of these other layers of training and bureaucracy are a failure."

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