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ASIPP ON-DEMAND VIDEOS
ASIPP PODCASTS
Here are some of the available ASIPP® Podcasts:
- A Discussion on Tolerance, Dependency, and PTSD with Dr. Joseph Cabaret and Dr. Kenneth Carle
- Dr. Amol Soin And The Business Side Of COVID-19
- Dr. Kevin Pho of KevinMD.com Reveals Terrific Insight And Ideas On The “New Norm” After The COVID-19
- Andrea Trescot, MD Takes On The Subject Of Controlled Substance Management
- ASIPP® Pod August 2019 – Distinguished Pain Leaders Prunskis, Prunskis, and Helm Discuss Issues That Face IPM
- Miles Day Of Texas Tech Discusses Multiple Pain Management Topics
ASIPP MEMBERSHIP
Join ASIPP. Your Voice For Interventional Pain Management
Medicare Releases Proposed LCD on Peripheral Nerve Blocks and Procedures for Chronic Pain With Elimination of Almost All Peripheral Nerve Blocks From Coverage Policy
All Medicare Administrative Contractors (MACs), including CGS, NGS, Noridian, Palmetto, and WPS, except Novitas and First Coast Service Options, have released new Local Coverage Determinations (LCDs) for peripheral nerve blocks and procedures for chronic pain.
The new LCDs provide coverage only for radiofrequency neurolysis for trigeminal neuralgia, corticosteroid injections for median neuropathy at the wrist (limited to a maximum of three injections), and corticosteroid injections for Morton’s neuroma (limited to a maximum of two injections).
All other peripheral nerve block and related procedures are not covered under these policies.
- Occipital nerve block and denervation
- Stellate ganglion block
- Trigeminal nerve block
- Suprascapular nerve block
- Thoracic nerve block
- Thoracic nerve denervation
- Genicular nerve blocks (GNB), cryoneurolysis or ablation
- Pudendal nerve block
- Digital nerve block
- Posterior tibial nerve block at the tarsal tunnel
- Ulnar nerve block
- Denervation of the trigeminal nerve for any diagnosis other than TN
- Any other peripheral nerves blocks, or denervation not listed above
This policy eliminates all procedures except for facet joint interventions and epidural interventions.
As practitioners, we recognize the clinical importance of these procedures. However, they are not performed very frequently, making it surprising that such a restrictive policy has been proposed—one that effectively removes nearly all other interventional options.
ASIPP will be submitting a formal comment letter and is urging all state societies to do the same.
Public comments are open until November 8 for CGS, NGS, Noridian, and Palmetto, and until November 22 for WPS.
Comments may be submitted directly through each Medicare Administrative Contractor (MAC) by using the links provided below:
NGS (DL40267):
Open Comment Period: closes 11/8
Noridian (DL40265):
Open Comment Period: closes 11/8
Palmetto (DL40263):
Open Comment Period: closes 11/8
CGS (DL40261):
Open Comment Period: closes 11/8
WPS (DL40300):
Open Comment Period: closes 11/22
We will stay in touch and provide you with a copy of the ASIPP letter. You will receive ASIPP’s official comment letter, which you can use as a reference to develop your own. However, if you would like to submit your letter before then, please feel free to do so.
When preparing your letter, please follow the principles below:
- Be respectful.
- Identify yourself and your practice.
- Clearly express your concerns.
- Offer solutions, if applicable. Possible recommendations include:
- Withdraw the LCD entirely.
- Modify coverage policies to allow two diagnostic blocks followed by two radiofrequency neurotomy procedures per year, if applicable, or four therapeutic nerve blocks.
- The treatment should be performed only if patients experience at least 50% improvement following both the first and second diagnostic blocks.
- Conclude your letter by thanking the MAC for their consideration.
- Keep in mind that the LCD itself includes detailed background information for each procedure.
- You may also reference supporting literature, either external sources or citations included within the LCD.
35-Year Analysis of Global Chronic Pain Trials Highlights Dr. Laxmaiah Manchikanti as Most Published Author and the Pain Physician Journal Takes Third Place
A 35-year bibliometric analysis of global trends in randomized controlled trials for chronic pain therapy (1989-2024) highlights Laxmaiah Manchikanti, MD, as a prominent author with the highest publication counts, while Pain Physician ranks as the third highest ranked journal. ASIPP Lifetime Director, Vijay Singh, MD, was also ranked in the top 10
The study, conducted by Yang et al., analyzed 4,206 publications from 939 journals, authored by 20,068 individuals across 86 countries. The most cited article was “Clinical Importance of Changes in Chronic Pain Intensity Measured on an 11-Point Numeric Pain Rating Scale” (Pain. 2001 Nov;94(2):149-158).
Most Published and Cited Authors:
- Laxmaiah Manchikanti, MD
- Andrew R. Moore, DSc
- Derry Sheena, MA
Top cited high-impact journals include:
- Pain
- Cochrane Database of Systematic Reviews
- Pain Physician
The tables below summarize:
- Publication and citation profiles of high-impact authors
- Bibliometric indicators of high-impact journals
For detailed data, please refer to the full article: https://journals.lww.com/md-journal/fulltext/2025/09260/global_trends_and_hotspots_of_randomized.107.aspx
Update on Medicare Operations: Telehealth, Claims Processing, and Medicare Administrative Contractors Status During the Shutdown
When certain legislative payment provisions (“extenders”) are scheduled to expire, CMS directs all Medicare Administrative Contractors (MACs) to implement a temporary claims hold. This standard practice is typically up to 10 business days and ensures that Medicare payments are accurate and consistent with statutory requirements. The hold prevents the need for reprocessing large volumes of claims should Congress act after the statutory expiration date and should have a minimal impact on providers due to the 14-day payment floor. Providers may continue to submit claims during this period, but payment will not be released until the hold is lifted.
Absent Congressional action, beginning October 1, 2025, many of the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 Public Health Emergency will take effect again for services that are not behavioral and mental health services. These include prohibition of many services provided to beneficiaries in their homes and outside of rural areas and hospice recertifications that require a face-to-face encounter. In some cases, these restrictions can impact requirements for meeting continued eligibility for other Medicare benefits. In the absence of Congressional action, practitioners who choose to perform telehealth services that are not payable by Medicare on or after October 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage. Practitioners should monitor Congressional action and may choose to hold claims associated with telehealth services that are not payable by Medicare in the absence of Congressional action. Additionally, Medicare would not be able to pay some kinds of practitioners for telehealth services. For further information: https://www.cms.gov/medicare/coverage/telehealth.
CMS notes that the Bipartisan Budget Act of 2018 allows clinicians in applicable Medicare Shared Savings Program Accountable Care Organizations (ACOs) to provide and receive payment for covered telehealth services to certain Medicare beneficiaries without geographic restriction and in the beneficiary’s home. There is no special application or approval process for applicable ACOs or their ACO participants or ACO providers/suppliers. Clinicians in applicable ACOs can provide these covered telehealth services and bill Medicare for the telehealth services that are permissible under Medicare rules during CY 2025, irrespective of further Congressional action. For more information: https://www.cms.gov/files/document/shared-savings-program-telehealth-fact-sheet.pdf.
MACs will continue to perform all functions related to Medicare Fee-for-Service claims processing and payment.
ASIPP Files Comments to CMS on Physician Fee Schedule: ASIPP Requests Elimination of Cuts, Introduction of a Modifier for Independent Physicians
CMS issued the proposed rule CMS-1832-P on July 16, 2025, titled Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program.
On September 11, 2025, ASIPP submitted a comment letter advocating for the following:
- Elimination of proposed efficiency adjustment, which is inappropriate, and efficiency is rather decreasing than increasing.
- Due to escalating costs, practice expense cuts applicable to independent physicians need to be addressed.
- Ambulatory Specialty Model (ASM) appears to be without evidence and inappropriate, putting independent physicians at high risk for survival; consequently, this should be eliminated or conducted voluntary trial for five years.
- Telehealth services must be made permanent.
Enclosed are ASIPP’s detailed comment letter, Chairman Comer’s recent letter to CMS and OMB, and 3 published articles addressing this issue.
- Manchikanti L, et al. Physician payment reform in interventional pain management: Balancing cost, quality, access and survival of independent practices. Pain Physician 2025; in press.
- Manchikanti L, et al. Non-partisan proposal for reforming physician payment system and preserving telehealth services. Pain Physician 2025; 28:E329-E335.
- Manchikanti L, et al. Escalating growth of spending on Medicare Advantage (MA) plans: Save Medicare from insolvency and balance the budget. Pain Physician 2025; in press.
Aetna and Cigna Announce Automatic Downcoding Policies
Background
- Aetna and Cigna have announced automatic downcoding policies for complex Evaluation & Management (E/M) services — specifically, level 4 and level 5 office visits.
- Aetna and Cigna are using algorithms or claims data alone to automatically downgrade the codes physicians assign to cases — without reviewing individual patients’ medical records.
- The result is that claims for complex visits will be paid at a lower level. Physicians who disagree with this automatic downcoding will have to appeal.
- That process will require submitting a significant amount of paperwork and patient case documentation — something many practices will not have the capacity or wherewithal to do.
- This “deny first, pay later” system presumes physicians are guilty of “upcoding” until proven innocent.
Issues we are facing:
- These new policies from Aetna and Cigna do not put patients first. They’re not about catching bad actors. They’re about boosting insurer profits at the expense of patient access and timely care.
- These policies threaten the viability of independent physician practice. Automatic downcoding will accelerate the collapse of independent practices that communities rely on for accessible, affordable care.
- Insurers are acting in bad faith. Aetna and Cigna are rewriting the rules of medical coding unilaterally, disregarding physician expertise and nationally recognized standards.
Potential Scope of the Policy
- Aetna and Cigna’s policies will have the potential to impact some of the most commonly billed codes
- According to CMS data of Medicare Part B E/M codes by specialty in CY 2022, E/M CPT code 99214 was the most frequently billed E/M code (of 114 codes tracked), representing 25% of allowed E/M claims. E/M CPT code 99215 was the sixth most frequently billed E/M code in the same data set, representing 3% of all codes billed.
- Overcoding of CPT codes 99214 and 99215 is de minimis
- According to a 2024 audit of Medicare FFS claims, CPT codes 99214 and 99215 overcoding represented 0.13% of paid Medicare FFS claims in 2024.
- Cigna anticipates that this new policy will affect less than 3% of eligible claims.
* This is a significantly greater percentage of claims than CMS data would suggest are actually overcoded
- When you consider the high volume of claims this would affect, and the low likelihood that they are incorrectly coded, it is difficult to justify this policy as anything more than a way for insurers to erect even more barriers to paying physicians for the services they have already provided
Effect on Patients
- These policies will force physicians to spend even more time doing paperwork that would have been better spent treating patients.
- Instead of treating patients, physicians will have to spend their time fighting the likes of Aetna and Cigna for just reimbursement.
- Aetna and Cigna are putting patients in the middle of a claims tug-of-war.
- Aetna and Cigna are using mysterious, opaque algorithms to second-guess the clinical judgment of the physicians that patients trust — and refusing to explain or justify their decisions.
Effect on Independent Physicians
- Independent practices lack the armies of coders and administrators that hospital systems have. They don’t have the capacity to play insurers’ bureaucratic games.
- Downcoded claims necessitate time-consuming appeals and effectively force practices to beg for payment for the care they’ve provided.
- A policy of automatic underpayment strains independent practices’ scarce resources.
- And by threatening independent practices’ financial viability, these policies hasten consolidation within the healthcare market.
- To avoid these administrative and financial headaches, independent practices accede to buyout offers from large hospitals and health systems.
- Such consolidation results in higher costs, fewer choices, and less personalized care for patients.
Backward Policy
- Both policies flout coding guidelines from the American Medical Association and the Centers for Medicare and Medicaid Services, which require review of medical records to determine visit complexity.
- Aetna and Cigna’s approach is opaque. Physicians do not know the criteria or algorithms being used, leaving them unable to avoid downcoding even if they code correctly.
- These actions may even conflict with federal and state law, including prompt-pay requirements and fair claims review standards.
Please find policies linked below:
Congress Moves to Extend Telehealth Access Through 2027
Bipartisan and bicameral bills have been introduced to extend telehealth access through fiscal year 2027.
Telehealth services have become a crucial part of modern medical practice, especially since the COVID-19 pandemic. They provide numerous benefits to patients, helping to address issues like transportation barriers, missed work for caregivers, and financial strains. Medicare has played a key role in expanding access to telehealth, benefiting not only rural Americans but also the broader population, as most insurers—except United Healthcare Commercial— have adopted these policies.
The Telehealth Modernization Act of 2025, led by Reps. Buddy Carter (R-GA) and Debbie Dingell (D-MI), ensures continued access to telehealth services for seniors and patients nationwide. A companion bill is being advanced in the Senate by Sens. Tim Scott (R-SC) and Brian Schatz (D-HI).
Lawmakers emphasized the critical role of telehealth in reducing barriers to care, improving access for rural and underserved patients, and modernizing healthcare delivery.
This legislation represents a major step toward securing long-term telehealth access for Medicare patients and strengthening its place in the U.S. healthcare system.
Requesting support to CMS and Congressional Members to Revise Proposed Physician Payment Rule to Separate the Cuts Applied for Hospital-Based Physicians from Independent Physicians
ASIPP is advocating strongly on behalf of interventional pain physicians, sending letters to Congress urging revisions to the proposed 2025 Physician Payment Rule from the Centers for Medicare & Medicaid Services (CMS). While ASIPP supports CMS’s goals of reducing waste, improving quality, and strengthening chronic disease management, the current proposal would have devastating consequences for interventional pain practices. These sweeping cuts risk accelerating healthcare consolidation, reducing patient access to pain specialists, and worsening physician burnout, at a time when practice costs are soaring, staff wages are rising, and reimbursement rates continue to fall.
Since 2001, interventional pain physicians have experienced some of the steepest cuts across all specialties, 41% through 2025, projected to reach 45% with the new rule. Even with modest office-based payment relief projected for 2026, the cumulative losses remain unsustainable.
In addition, CMS is introducing an Ambulatory Specialty Model (ASM) that will begin a trial phase in select states starting January 2027 and continue for five years through December 31, 2031.
This pilot will focus on two chronic conditions, low back pain and heart failure, with the following objectives:
- Prevent the worsening of chronic conditions
- Identify risks and early signs of chronic conditions
- Improve patient experience
- Reduce unnecessary procedures and surgeries
The specialties included are interventional pain management, anesthesiology, neurosurgery, orthopedic surgery, and physical medicine and rehabilitation. During the first payment year, adjustments will range from -9% to +9%, with all participants subject to this risk. Participation is mandatory, not optional.
However, there is no established or evidence-based guidance for this model, which significantly increases the risk for pain specialists. Pain specialists do not manage acute pain and have no control over many of the associated costs, yet they would still be held accountable for overall patient spending. These payment adjustments may apply to all Medicare services.
ASIPP urges CMS to eliminate the ASM until appropriate criteria are established and the model’s effectiveness is demonstrated.
ASIPP is urging Congress to:
- Reverse the proposed 2.5% efficiency adjustment to work RVUs and stop the cycle of devastating cuts every three years.
- Promote equitable treatment of independent pain practices in practice expense allocations, especially for services provided in Ambulatory Surgery Centers.
- Ensure the permanent extension of telehealth access beyond 2025, critical for chronic pain patients in rural and underserved areas.
- Direct CMS to distinguish reimbursement reductions between hospital-employed and independent physicians, protecting small pain practices from disproportionate harm.
- Ask CMS to withdraw this provision pending the development of appropriate criteria and validation of the model’s effectiveness.
Without these revisions, independent interventional pain practices, already under audit pressure and burdened by prior authorization requirements, face an uncertain future. Preserving their viability is essential to maintain patient access to timely, high-quality pain care and to prevent further healthcare consolidation that continues to drive up costs by 200–300%.
SAMPLE LETTER TO SEND TO REPRESENTATIVES IN CONGRESS
ASIPP has prepared a sample letter you can personalize and send to your representatives in Congress.
Click here to find your congressional members
By speaking out, you can help stop devastating cuts, protect independent interventional pain practices, and preserve patient access to high-quality pain care.
Please click here for a sample letter to send to your representatives.
SAMPLE LETTER TO SUBMIT COMMENTS TO CMS
For your convenience, we are enclosing a sample letter for you to customize and send to CMS to express concerns with the 2025 Medicare Physician Fee Schedule.
Please click here for a sample letter to submit your comments to CMS.
INFORMATION FOR SUBMITTING YOUR COMMENT LETTER
In commenting, please refer to file code CMS-1832-P. Comments must be received no later than 5 p.m. on September 12, 2025.
Click here to submit electronic comments on this regulation.
Please do not hesitate to contact us if you have any questions or would like additional information.
Thank you,
Laxmaiah Manchikanti, MD
Chairman of the Board and Chief Executive Officer, ASIPP and SIPMS
[email protected]
Mahendra Sanapati, MD
ASIPP President
[email protected]
Non-Partisan Proposal for Reforming Physician Payment System and Preserving Telehealth Services
Physician payments have declined significantly due to budget neutrality rules and reimbursement cuts. Since 2001, Medicare payments to physicians have dropped by 33% when adjusted for inflation. These reductions have been compounded by 2% annual sequestration cuts introduced after the Affordable Care Act (ACA), which continues through 2032. Despite their long-term impact, sequestration cuts receive little public attention.
Congress has historically delayed or softened these cuts. However, in 2025, a bill that would have adjusted payment rates was removed from the continuing resolution, resulting in continued reductions. Meanwhile, insurance premiums have risen nearly 400%, highlighting the disparity between healthcare costs and physician compensation.
Ironically, while physicians face significant payment cuts, the Centers for Medicare & Medicaid Services (CMS) proposed on January 10, 2025, a 4.3% payment increase for Medicare Advantage plans—totaling $21 billion in 2026 and an estimated $210 billion over the following decade starting in calendar year 2026. This proposal comes amid ongoing concerns about Medicare Advantage overpayments, estimated at nearly $100 billion annually, and additional funding through annual premiums of $198 from all Medicare beneficiaries, amounting to roughly $13 billion per year.
In response, the American Society of Interventional Pain Physicians (ASIPP) submitted a nonpartisan reform proposal advocating for telehealth protections and elimination of sequester cuts—measures that have received strong bipartisan support in Congress.
Both the House of Representatives and the Senate voted to pass a reconciliation bill—nicknamed the “Big Beautiful Bill”, which has been signed into law by the President recently. It proposes an $8.9 billion investment in the Medicare Physician Fee Schedule, with a 2.25% update in 2026.
The proposal does not address the budget neutrality provision, growing practice costs, inflationary pressures, or ongoing sequestration and pay-as-you-go (PAYGO) cuts. It also fails to resolve issues with the Medicare Access and CHIP Reauthorization Act (MACRA), particularly within the Merit-Based Incentive Payment System (MIPS).
On November 1, 2024, CMS finalized a 2.8% cut to physician payments—an estimated $20 billion—while also eliminating telehealth services. These cuts continue to threaten physician sustainability and patient access to care.
📄 Read the full Pain Physician Journal article here → https://www.painphysicianjournal.com/current/pdf?article=ODAyNA%3D%3D
IMPORTANT NEWS!
Medicare Physician Fee Schedule & Ambulatory Surgery Center Rule
CMS proposes a 3.8% payment increase for physicians, the first in 5 years, along with a 2.6% increase for ASC payments and an 8%–10% increase for office-based services. However, payments for hospital and ASC-based physician services are reduced by 8%–10%.
PHYSICIAN PAYMENTS
On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS). The rule introduces significant changes to physician payment policies and updates to the Quality Payment Program (QPP), including the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
KEY PROPOSED CHANGES:
1. Conversion Factor (CF) Updates
- Proposed Conversion Factor Increase:
- The proposed conversion factor for qualifying participants (QPs) is $33.59 (a 3.83% increase from 2025), and for non-QPs, it is $33.42 (a 3.62% increase).
- These increases reflect a one-time 2.5% statutory payment adjustment from the One Big Beautiful Bill Act, in addition to other updates.
- ASIPP’s Comments:
- ASIPP welcomes the proposed increases but cautions that much of the adjustment is temporary, raising concerns about potential future pay cuts. ASIPP continues to advocate for a permanent inflationary adjustment and the elimination of budget neutrality constraints. Notably, ASIPP has submitted a nonpartisan proposal to reform Medicare physician payments, which includes a permanent fix and the elimination of the 2% sequestration cuts (https://asipp.org/draft-drm-non-partisan-proposal-for-reforming-2/).
We are already experiencing clawbacks from increases provided during the COVID-19 pandemic under the Trump Administration, with ongoing rulemaking leading to a 2.8% cut for 2025. Furthermore, the 2% sequestration cut, originally intended to expire years ago, has now been extended until 2031.
2. Efficiency Adjustment
- Purpose: CMS proposes a new -2.5% efficiency adjustment for non-time-based codes, applied every 3 years.
- CMS Rationale: This adjustment reflects concerns about potentially overestimated time assumptions and aims to account for increasing physician efficiency.
- ASIPP’s Comments: ASIPP supports initiatives that encourage efficiency; however, applying a reduction in work value for perceived efficiency gains is inappropriate. Despite advancements in EMRs and AI, administrative burdens have only increased, leading to greater stress rather than relief.
Additionally, physicians face growing challenges with preauthorizations, expanding Medicare regulations (including LCDs), and cascading requirements from Medicare Advantage Plans, Medicaid, and private insurers. These are compounded by ongoing audits, with approximately 30% of interventional pain physicians under audit at any given time. IPM physicians are dedicating significant time to documentation, preauthorizations, and compliance with LCDs and medical policies. As such, a 2.5% reduction in work value, without accounting for inflation or the cumulative 33% reduction in physician payments from 2001 to 2025, raises serious concerns.
3. Practice Expense (PE) Methodology
- Proposed Change: CMS proposes reducing the portion of indirect PE for facility-based services, citing outdated assumptions and the increasing trend toward hospital employment.
- CMS Rationale: The goal is to discourage hospital consolidation and promote payment parity across care settings.
- Impact: This proposal could result in approximately 10% total RVU reductions for facility-based (hospital and ASC) interventional pain management (IPM) services.
- ASIPP’s Comments: ASIPP is deeply concerned about the negative impact on independent practices. There must be an appropriate methodology to address this issue. The vast majority of physicians practicing in ASCs—and many non-primary care independent practitioners—also provide care in hospital settings. Importantly, many procedures cannot be performed in office settings, and not all physicians are equipped to offer these services outside ASCs. In many cases, Ambulatory Surgery Centers effectively serve as an extension of a physician’s office. ASIPP urges CMS to revise this policy by distinguishing between procedures performed in ASCs and those in hospital settings, and by implementing a methodology to differentiate independent physicians from hospital-based physicians.
4. Telehealth
- No proposed extension: CMS’s proposed rule does not provide any evidence or statements supporting a permanent extension of telehealth services.
- CMS proposed changes: However, CMS does propose permanent changes such as a revised definition of “direct supervision.”
- Our sources at CMS indicate that telehealth is included in the 2026 physician fee schedule.
BRIEFLY:
ASIPP analysis indicates that office payments, including physician payments, for procedures and evaluation and management (E/M) services are expected to increase by approximately 10%.
Conversely, payments to physicians for services performed in hospitals or ASCs, whether by independent or hospital-based physicians, are projected to decrease by about 8%, including reductions to E/M services.
SUMMARY OF PHYSICIAN PAYMENT REFORM
2026 Proposed – Physician Payment Rates Compared to 2025 (https://asipp.org/2026physicians_proposed/)
2026 AMBULATORY SURGERY CENTER RULE
The Centers for Medicare & Medicaid Services (CMS) has proposed a 2.4% payment increase for Ambulatory Surgical Centers (ASCs) in the CY 2026 payment rule. This increase is contingent upon ASCs meeting quality reporting requirements. Additionally, CMS proposes significant expansions to the ASC Covered Procedures List (ASC-CPL), allowing a broader range of procedures to be performed in ASCs.
Payment Rate Increase:
- CMS proposes a 2.4% payment increase for both Ambulatory Surgery Centers (ASCs) and Hospital Outpatient Departments (HOPDs).
- This increase reflects a 3.2% market basket update, offset by a 0.8% productivity adjustment—consistent with the Inpatient Prospective Payment System (IPPS) update factor.
2026 ASC Proposed Payment Rates Compared to 2025 Rates https://asipp.org/2026asc_prposed/)
SUMMARY OF CMS PAYMENT RULES
This summary highlights the good, the bad and the ugly.
Good:
- Conversion factor increase of 3.6% to 3.8%.
- Payment increases of approximately 10% for office procedures and 7%–10% for evaluation and management (E/M) services.
- 2.6% payment increase for Ambulatory Surgery Center (ASC) services.
Bad:
- No permanent extension of telehealth services, despite multiple established rules. However, our sources indicate telehealth is included.
- A 2.5% efficiency adjustment applied to work RVUs for non-time-based services.
Ugly:
- 8%–10% reductions in physician payments for services provided in hospitals or ASCs. Our sources indicate telehealth is included.
In addition, physicians continue to face increasing administrative burdens, including preauthorizations, expanding Medicare regulations through LCDs (which are adopted by Medicare Advantage Plans, Medicaid, and incorporated into private medical policies), and frequent audits. At any given time, approximately 30% of interventional pain physicians are under audit. This has resulted in significant time spent on documentation, preauthorizations, and adherence to the appropriateness criteria set by LCDs and medical policies.
This is not a realistic assessment, given that physician payments have already decreased by 33% since 2001. The situation is further compounded by an ever-growing number of rules, regulations, and administrative burdens associated with EMRs—and now AI. Physician workload continues to rise, not fall. Remember the concept of “pajama time,” as many physicians work late into the evening to complete their documentation.
- The proposed conversion factor increase is only a temporary measure and may be clawed back, similar to the post-COVID cuts that followed payment increases under the Trump Administration.
- ASCs are being grouped with hospitals, despite being overwhelmingly owned and operated by independent physicians.
- ASCs essentially function as extensions of office practices.
- Independent physicians providing services at hospitals and ASCs are inaccurately classified as hospital-based physicians.
While ASIPP appreciates the positive changes, it continues to advocate for revisions to the fee schedule that distinguish independent physicians from hospital-based physicians. This distinction is critical to ensure that independent physicians working in hospitals and ASCs are not unfairly subjected to payment reductions intended for hospital-employed providers.
GABOR B. RACZ, MD, IN MEMORIAM
It is with profound sadness and a deep sense of loss that we share the passing of our beloved teacher, mentor, friend, and colleague, Gabor Bela Racz, MD, who passed away peacefully in his sleep in the early hours of June 21, 2025. Widely recognized as a Giant in pain management worldwide and awarded by the American Society of Interventional Pain Physicians (ASIPP) with this award, Dr. Racz’s contributions shaped the very foundation of our field.
Though he earned global acclaim, many of us remember him best as the long-serving Professor and Chair of Anesthesiology in Lubbock, Texas, where he trained hundreds of fellows and countless other physicians. He was an innovator at heart, pushing the boundaries of interventional pain medicine with vision and precision. I recall, even as early as 1982 when I began my anesthesiology practice, Dr. Racz had already pioneered the use of a spring, shear-resistant catheter to perform epidural injections in patients with epidural fibrosis—an innovation inspired by the kinking of an intravenous catheter in a pregnant patient. This eventually became the percutaneous epidural neuroplasty, known worldwide as the “Racz Procedure”, now performed hundreds of thousands of times across the globe.
His pioneering work extended beyond catheters and techniques. He applied this same catheter for intrathecal phenol injections for cancer pain and later combined it with hypertonic saline for adhesiolysis, further refining and standardizing these procedures.
Dr. Racz’s educational impact was equally far-reaching. Together with Dr. Prithvi Raj, he co-founded the World Institute of Pain (WIP), and the Annual Gabor Racz Pain Conference in Budapest stands as a testament to his enduring legacy.
He consistently emphasized that every procedure must be SAFE (safe, appropriate, fiscally responsible, and effective), he advanced multiple interventional techniques for both cancer and non-cancer pain, including early work in neuromodulation. Despite his towering influence across continents, it is humbling to remember that he began his life in Budapest (born 1937), fleeing Hungary during the 1956 Revolution with his beloved wife Enid, and later making the United States his home. He raised a loving family and found joy in the company of his children and grandchildren.
On a personal note, I first met Dr. Racz during a breakfast meeting—an encounter that led me to begin performing adhesiolysis. When I once faced a complication with a retained catheter, he personally guided me through the resolution. He had a gift for recognizing and encouraging original thinkers, and I was honored to receive the Trailblazer Award from him through WIP. I cherish the photographs from his visit to Paducah, KY, where he and Enid spent time with us, along with Drs. Prithvi and Susan Raj. These moments and memories hang proudly in my home and office.
Dr. Racz will be remembered not only for his unparalleled contributions to pain medicine but also for his compassion, mentorship, and enduring humanity. His absence leaves a void that will not be easily filled—but his legacy will live on through every life he touched and every procedure he refined.
While we miss him sorely, this is the time we can memorialize him. If you are interested in writing about him, please submit the manuscripts to Pain Physician. You will be waived the submitting fee.
Limits are as follows:
Abstract: Up to 250 words
Text: Maximum of 3,000 words
You can use pictures, references, etc. which are outside the limits.
Following Memoriam Provided by Standiford Helm, MD
Gabor Bela Racz, MD passed away peacefully in his sleep in the early hours of June 21, 2025. With his passing, we have lost one of the great figures of interventional pain management.
Dr. Racz was born and raised in Budapest. He left Budapest in the turbulent days of the 1956 Hungarian revolution with his wife of sixty-four years. One can still see the chip created in the building by a bullet intended for him.
Dr. Racz was able to make his way to England, where he completed his medical education and played on the English national water polo team. He was able to emigrate to the United States, where he started his academic career at Syracuse, NY. In 1977, he moved to Texas Tech, where he developed and ultimately led the pain program.
Dr. Racz’s academic career was characterized by ceaseless efforts to improve and innovate. A few weeks before his passing, his conversation focused on potential medical innovations and areas for new research. As early as 1976, he pioneered the use of spring-wound, shear-resistant catheter. Initially, this catheter was used to aid in the proper intrathecal placement of phenol for cancer. Coupling this development with an appreciation of the use of hypertonic saline, it was a short step to the creation of the percutaneous adhesiolysis procedure, whose shorthand name is the Racz procedure, done with a Racz catheter.
Dr. Racz’s educational efforts continued on an international scale. He was instrumental in developing the World Institute of Pain, which will be holding the 28th Annual Gabor Racz Pain Conference later this year.
Dr. Racz believed in the three pillars of interventional pain management, efficacy, safety, and patient access. He was always focused on how to change procedural techniques to avoid complications. The blunt needles whose use he pioneered changed the risk profile of arterial impingement.
Gabor Racz’s passion was his belief that no one should live in pain. He believed in his patients and was determined to support and heal them. He was more than a physician; he was their hero.
He said, “Treat your patient as if they were your own mother.”
BREAKING NEWS! Impact of One Big Beautiful Bill on Physician Payment Reform
The budget reconciliation package passed on Thursday, May 22, and included several provisions that would significantly impact physician payments and healthcare overall. Unfortunately, there is no unequivocally good news; rather, we are faced with a mix of potentially good, bad, and ugly developments.
Maybe Good News
Medicare Physician Fee Schedule Updates:
1. Initial Increase: The bill proposes a 2.25% Medicare pay update for physicians in 2026, based on 75% of the Medicare Economic Index (MEI), at a projected cost of $8.9 billion for that year.
Bad News
1. Future payment updates would be tied to the MEI, which tracks inflation and physician practice costs.
However, while linking payment updates to the MEI is a step in the right direction, concerns persist that the proposed MEI updates—capped at 10% annually—will not keep pace with actual inflation and rising practice expenses. This could result in effective increases of less than 0.5%.
2. The physician payment conversion factor is based on three components, including:
• An inflationary index, which is currently projected as 0% for 2025.
• A budget neutrality adjustment would apply solely to physician payments.
• Payments would continue to be influenced by the Merit-Based Incentive Payment System (MIPS). Consequently, CMS retains the authority to convert even minimal positive inflation adjustments into negative adjustments.
3. The continuation of 2% sequestration cuts, initially implemented after the Affordable Care Act, is set to extend through 2032.
4. Broader healthcare provisions will also affect physicians. These include Medicaid cuts, implementation of work requirements, and reductions in multiple assistance programs, which are likely to lead to decreased Medicaid enrollment.
What Is Ugly?
• What is particularly troubling is the ongoing instability of the physician payment system and the continued imposition of 2% sequestration cuts.
• Overall payment reductions could reach as high as 6%, despite the proposed MEI-based increases.
We find ourselves in a critical situation. ASIPP has long been engaged in addressing these challenges through a non-partisan proposal to reform the physician payment system and safeguard telehealth services. The bill is now before the Senate. Please contact your senator individually, through your group, patients, or staff—and urge them to support meaningful reform of the physician payment system. You may also use the convenient link set up by ASIPP: https://www.votervoice.net/ASIPP/Campaigns/127211/Respond
ASIPP Submits Letters to Carelon and Humana Regarding Coverage for Interventional Pain Management Procedures
BREAKING NEWS! ASIPP Submits Non-Partisan Reconciliation Proposal for Physician Payment Reform
Recently, ASIPP submitted to members of Congress, a non-partisan proposal for budget reconciliation for the preservation of Medicare and Medicaid and the reform of the physician payment system.
This proposal is in response to the escalation of health care spending in the United States, which in 2023 was close to $4.9 trillion, a 7.5% increase from the previous year the Congressional Budget Office (CBO), and other sources indicate that net Medicare spending—after accounting for beneficiary premiums—is projected to total $14 trillion over the next decade. Simultaneously, the financial sustainability of physician practices is increasingly under pressure.
Over the past 24 years, physician payment rates have declined by 33%, while practice costs have steadily risen. The cost of medical equipment, supplies, and technology has grown from $30.2 billion in 2017 to $57 billion in 2023, reflecting an average annual growth rate of 6.5%. The overall increase in practice expenses may be even greater, compounding the financial challenges faced by providers. Additionally, a widening gap has emerged: while physician payments have declined, other health care sector payments have continued to rise. Perhaps the most striking is the contrast between insurance premium growth and physician reimbursement rates, with premiums increasing nearly 400% while physician payments have dropped by 33%.
ASIPP’s recommendations build upon previous analyses from MedPAC, CMS, OIG-HHS, and the CBO. The largest projected savings are expected to result from proposed reforms to the Medicare Advantage program exceeding 120 billion per year. Exceeding 120 billion per year, with an estimated savings from specific changes which include:
· Cancellation of the proposed 4.3% payment increase for 2026:
$21 billion per year, or $210 billion over 10 years
· Elimination of payments for veterans already covered by VA insurance:
$15 billion per year, or $150 billion over 10 years
· Ending favorable selection practices: $44 billion per year, or $440 billion over 10 years
· Reforming risk adjustment mechanisms:
$40 billion per year, or $400 billion over 10 years
Collectively, these measures would generate an estimated $120 billion in annual savings from the Medicare Advantage program—totaling $1.2 trillion over a 10-year period.
Click here for the full 48-page Budget Reconciliation proposal. Please consider sending a PAC contribution using the following link: Click HERE to contribute to the ASIPP-PAC.
We cannot emphasize strongly enough how important your contributions are to the work we do toward the preservation of healthcare and especially interventional pain management.
ASIPP Responds to Damaging BMJ Publications Threatening Patient Access to Interventional Spine Care
The American Society of Interventional Pain Physicians (ASIPP) expresses grave concern regarding two recent publications in the British Medical Journal (BMJ) that risk significantly limiting patient care and choice in the management of chronic non-cancer spine pain.
- Letter from ASIPP President, Christopher Gharibo, MD
- Letter from ASIPP Chairman of the Board and CEO Laxmaiah Manchikanti, MD; ASIPP President-Elect Mahendra Sanapati, MD; and Academic Director, Joshua Hirsch, MD
- Formal withdrawal request
To continue this vital conversation, ASIPP will host a dedicated one-hour session at its 2025 Annual Meeting in Orlando. The session will take place on Saturday, May 17, and will be co-chaired by Dr. Christopher Gharibo and Dr. Nick Knezevic. It will include a 30-minute panel discussion with panelists: Alaa Abd-Elsayed, MD; Salahadin Abdi, MD, PhD; Sheri Albers, DO; Alexander Bautista, MD; Miles Day, MD; Shravani Durbhakula, MD; Alan Kaye, MD, PhD; Sean Li, MD; Laxmaiah Manchikanti, MD; Deborah Tracy, MD; Vinita Singh, MD; and Michael Schatman, PhD. ASIPP invites all to attend this important session. Register here.
ASIPP Advocacy Update: ASIPP Recently Met with Congress to Advocate for Several Critical Issues, Including the Extension of Telehealth Services
We want to update you on our recent visit to Washington where several ASIPP members met with key members of Congress, in both the House and Senate.
We advocated for several critical issues, including the extension of telehealth services. While we were unable to secure a permanent extension, we successfully obtained a six-month extension and will continue working for a long-term solution. Additionally, we are making progress on fraud and abuse legislation which will soon be ready for introduction.
We are also working to eliminate the recurring two-percent sequester cut and address abuses in Medicare in Medicare Advantage Plans.
Finally we discussed coverage for Peripheral Nerve Stimulation and emerging CPT coding challenges. We will be sending you a letter soon regarding ASIPP’s advocacy efforts. We encourage you to join us in these important initiatives.
BREAKING NEWS: Bill Passes House for Telehealth Provisions – Senate Must Approve for a 6-Month Extension
Through ASIPP’s extensive advocacy efforts, we were successful in getting language included in the continuing resolution to fund the government through September. This resolution would extend telehealth provisions for another 6 months.
The bill passed in the House on Wednesday while the ASIPP group was still on Capitol Hill. It appears that the extension is working its way through the Senate for approval. We are encouraged, but it has not yet been finalized.
While this is a temporary measure, our focus remains on securing a long-term solution. Many members of Congress and the Senate are advocating for a more permanent extension, ideally lasting 5 to 6 years or longer. ASIPP will continue pushing for this critical advancement.
We will provide further updates on our Capitol Hill visits and ongoing advocacy efforts soon.
BREAKING NEWS! Pain Medicine Case Reports journal has been accepted for inclusion in MEDLINE and PubMed
The American Society of Interventional Pain Physicians is excited to announce that Pain Medicine Case Reports journal (eISSN 2768-5152) has been accepted for inclusion in MEDLINE and PubMed, the prestigious bibliographic database of the U.S. National Library of Medicine. Pain Medicine Case Reports, a companion publication to the prestigious Pain Physician journal by ASIPP, joins its counterpart in achieving indexing in both MEDLINE and PubMed, marking ASIPP’s dual presence in these renowned databases.
The inclusion of Pain Medicine Case Reports journal in MEDLINE signifies a higher level of selectivity, as MEDLINE consists of the top 5,200 biomedical journals. This indexing also means that articles from Pain Medicine Case Reports will be searchable using NLM Medical Subject Headings (MeSH terms) and other metadata.
The selection for MEDLINE follows a rigorous evaluation process by reviewers from the Literature Selection Technical Review Committee (LSTRC). According to their criteria, the scientific quality of a journal’s content is the primary factor considered for indexing.
We extend our congratulations to the Pain Medicine Case Reports Editor-in-Chief, Deputy Editor-in-Chief, Journal Team, and Editorial Board for this achievement, which underscores the significance and excellence of this esteemed journal.
EXTREMELY IMPORTANT NEWS! Telehealth Changes in the Final Rule 2025 of Physician Payments CMS-1807-F and CMS-4201-F5
Thank you for your attention and participation in various activities in protecting medical practices.
We want to bring to your attention critical issues affecting patients across the United States, including those covered by Medicare, Medicare Advantage, Medicaid, and commercial insurers.
The Medicare Final Rule has significantly changed the provision of telehealth services. Starting April 1, 2025, most telehealth services will require patients to be physically present in an office or medical facility located in a rural area. This restriction excludes patients in non-rural areas from accessing telehealth services altogether. Even for those in rural regions, traveling to a designated facility can be extremely difficult, undermining one of telehealth’s primary benefits—providing care from the patient’s home. These changes will impose substantial transportation costs, create burdens for elderly patients who cannot drive, and disrupt the working population that relies on telehealth for accessible care. Currently, approximately 20% of patients depend on telehealth services.
Furthermore, if this rule remains in place, Medicare Advantage, Medicaid, and commercial insurers are expected to adopt similar policies, likely with reduced reimbursements. This will effectively dismantle telehealth services, severely limiting patient access to essential health services.
This issue is crucial for millions of patients across the country, and we hope you will take action to help preserve access to these vital services. We urgently request you to contact CMS and members of Congress (House and Senate).
Please go to VoterVoice and from there, send your letters. You may also copy the letter into your own letterhead or e-mail it directly. We have created a sample letter for your convenience.
IMPORTANT NEWS! Medicare MACs Will Hold Claims Until January 14 Instead of January 28 as Previously Notified
Some of you may have received notices from Medicare that they will be holding claims until January 28, so that CMS can make necessary claim system updates. Holding them for 28 days is very difficult for providers to cope with.
ASIPP has contacted CMS through our advocacy team of Jeff Mortier and Randi Hutchinson. Chairman James Comer and Senator John Boozman contacted them on our behalf and expressed concern on the policy. Following this, they received a response from CMS stating that they will be holding claims until January 14 instead of the 28th to make the necessary claims system updates, which is part of the normal process.
The following is the full text from CMS:
The MACs are holding claims until January 14th to make the necessary claims system updates, which is part of the normal process when we implement extenders legislation. The MACs should not be denying these claims. CMS has directed the MACs to make any necessary changes before claims are released to pay telehealth claims dates of service 1/1/25 through 3/31/25 with all of the same flexibilities that applied to telehealth and related services for 2024. In addition, if any claims were processed incorrectly, the MACs have been directed to automatically adjust the claims.
CMS is also actively working to update public-facing information to ensure health care providers and beneficiaries are aware of the temporary extension.
We hope this information will be helpful to you. If you have any issues for beyond January 14, please feel free to contact us so we can contact CMS.
Updated Information on the 2025 Medicare Physician Fee Schedule
Peripheral Nerve Stimulation
Guidelines Available!
The Evidence-Based Clinical Guidelines for the Use of Implantable Peripheral Nerve Stimulation in the Treatment of Chronic Pain from ASIPP are now available! This 92-page publication includes 374 references, 20 tables (plus 8 appendix tables), and 9 figures.
These guidelines support the use of implantable peripheral nerve stimulation leads and neurostimulators in patients with moderate to severe chronic pain refractory to two or more conservative treatments, and aim to optimize patient outcomes and promote health equity through the integration of PNS technology in clinical practice.
Find the full updated guidelines here.
CMS Releases Final 2025 Fee Schedule
CMS has finalized the 2025 Medicare Physician Fee Schedule, implementing a 2.83% cut to Medicare physician reimbursements, as previously outlined.
This cut continues a long trend of decreased reimbursements, originating with the Budget Control Act of 2011 under the Affordable Care Act. As a result, sequester cuts of 2% will remain in effect until 2032 unless Congress enacts a permanent fix to prevent these annual adjustments.
Impact on Interventional Pain Management (IPM) Services:
The final schedule reflects a 2.83% reduction in reimbursements for IPM services.
New Bipartisan Legislation Introduced to Counter Cuts:
Congressman Greg Murphy, M.D., has introduced a bipartisan bill to address this issue. This legislation aims to prevent the proposed reimbursement cut and introduce a payment increase (1.8%) equal to half of the Medicare Economic Index, aligning with recommendations from the Medicare Payment Advisory Commission.
The bill has garnered support from AMA, numerous organizations, including ASIPP. We encourage all members to act by contacting your congressman and senators to support this legislation.
ASC:
There are no major changes for IPM procedures in ASC settings, aside from adjustments in specific codes. Notably, there is a 2% to 3% increase for codes 62361, 62360, 61885, 64590, and 62362, while codes 63688, 64595, 63664, 64585, 63662, 64569, 62350, and 64553 will see a 5% to 7% decrease.
New ICD Codes Effective October 1, 2024
The new ICD-10 codes, effective October 1, 2024, must be implemented immediately to ensure proper reimbursement, including for UDS claims.
The following new codes have been developed:
M51.360: Other intervertebral disc degeneration, lumbar region with discogenic back pain only
Other intervertebral disc degeneration, lumbar region with axial back pain only.
M51.361: Other intervertebral disc degeneration, lumbar region with lower extremity pain only
Other intervertebral disc degeneration, lumbar region with leg pain only.
Other intervertebral disc degeneration, lumbar region with referred sclerotomal pain only.
M51.362: Other intervertebral disc degeneration, lumbar region with discogenic back pain and lower extremity pain
Other intervertebral disc degeneration, lumbar region with discogenic back pain and leg pain.
Other intervertebral disc degeneration, lumbar region with axial back pain and referred sclerotomal pain.
M51.369: Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain
Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or leg pain.
Other intervertebral disc degeneration, lumbar region, NOS.
M51.370: Other intervertebral disc degeneration, lumbosacral region with discogenic back pain only
Other intervertebral disc degeneration, lumbosacral region with axial back pain only.
M51.371: Other intervertebral disc degeneration, lumbosacral region with lower extremity pain only
Other intervertebral disc degeneration, lumbosacral region with leg pain only.
Other intervertebral disc degeneration, lumbosacral region with referred sclerotomal pain only.
M51.372: Other intervertebral disc degeneration, lumbosacral region with discogenic back pain and lower extremity pain
Other intervertebral disc degeneration, lumbosacral region with discogenic backpain and leg pain
Other intervertebral disc degeneration, lumbosacral region with axial back pain and referred sclerotomal pain
M51.379: Other intervertebral disc degeneration, lumbosacral region without mention of lumbar back pain or lower extremity pain
Other intervertebral disc degeneration, lumbosacral region without mention of lumbar back pain or leg pain
Other intervertebral disc degeneration, lumbosacral region, NOS
M54.5: Low back pain
Excludes1: intervertebral disc degeneration, lumbar region with discogenic back pain only(M51.360)
intervertebral disc degeneration, lumbosacral region with discogenic back pain only(M51.370)
M54.3: Sciatica
Excludes1: intervertebral disc degeneration, lumbar region with lower extremity pain only(M51.361)
intervertebral disc degeneration, lumbosacral region with lower extremity pain only(M51.371)
M54.4 Lumbago with sciatica
Excludes1: intervertebral disc degeneration, lumbar region with discogenic back pain and lower extremity pain (M51.362)
intervertebral disc degeneration, lumbosacral region with discogenic back pain and lower extremity pain (M51.372)
However, these codes have not been updated with Medicaid, etc. Consequently, for facet joint pain the codes remain M47.816 and M47.817.
Similarly for radicular pain, lumbar radiculitis, M51.16 and M51.17 will remain.
See the following link to CMS: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56818&ver=45&=
Updated Antithrombotic Guidelines Available!
The updated Antithrombotic Guidelines from ASIPP are now available! This 94-page publication includes 412 references, 23 tables, and 15 figures, and offers crucial insights based on extensive research.
CMS Proposes 2025 Physician Fee Schedule with 2.8% Reduction and Ambulatory Surgical Center Payment System with a 2.6% Increase:
Overall Bad News with Sequester Cuts Remaining in Place
1. Proposed 2025 Physician Fee Schedule
On July 10th, CMS released the proposed rule for the 2025 Medicare physician fee schedule (MPFS). Rule focuses on several key goals of administration, including addressing health disparities, expanding access to behavioral health care, improving transparency in health system, and promoting safe, effective, and patient centered care.
The highlights are as follows:
- The rule proposes to cut the conversion factor by 2.8% to $32.36 in CY 2025, as compared to $33.29 in CY 2024.
The cut reflects the expiration of the 2.93% statutory payment increase for 2024, a 0% conversion factor update, and a 0.5% budget neutrality adjustment.
In the past, Congress has avoided those cuts with an annual “doc fix” bill, and many lawmakers with whom ASIPP has been in contact, along with other organizations are seriously discussing a more permanent solution this year. It is a matter of resolve and transfer of money from one place to the other.
- The proposal rule also adds payment for G2211 (an add-on code per visit complexity) even in some instances when modifier 25 is used.
- Telehealth will be extended until December 2026, based on a bill in the Congress. https://www.congress.gov/118/bills/hr7623/BILLS-118hr7623ih.pdf
- Sequester Cuts
As we have been experiencing for several years since the Budget Control Act of 2011 for Affordable Care Act, sequester cuts will continue at 2% until 2032. This issue is also being considered by Congress for permanent fix without recurring issues each year.
- Effect on IPM Services
- Changes reflect 2.8% cut
2. Ambulatory Surgical Center Payment System
2025 Medicare hospital outpatient prospective payment system and ambulatory surgical center payment system proposed rule on July 10, 2024, emphasizes addressing health disparities, expanding access to behavioral healthcare, improving transparency in the health system, and promoting safe, effective, and patient-centered care.
Good news on the ASC part is that there is an increase in payment rates of 2.6%.
Again, this does not include 2% continuous sequester cut which we are working on permanently eliminating.
- Effect on IPM services:
As you see from the fee schedule, it appears that there will be following increases:
- 3.7% increase for epidurals, intercostal nerve blocks, sacroiliac joint injections, and spinal cord stimulation procedures.
- 2.5% increase for radiofrequency neurotomy procedures
- 1.5% increase for transforaminal and facet joint injections
Comments can be made on both policies and are due by September 9, 2024.
Extension of Telehealth Modernization Act of 2024
The Telehealth Modernization Act of 2024, a bipartisan, bicameral legislation, is progressing through Congress, which includes the following:
- Extension of certain telehealth flexibilities removing geographic requirements and expanding origination sites for telehealth services and extending them through the end of December 31, 2026 (was scheduled to expire 12/31/2024).
- This legislation also allows and extends audio only telehealth services, through December 31, 2026 (was scheduled to expire 12/31/2024).
This is great news for patients and providers to maintain access, convenience and to provide cost effective established evaluation and management services. The legislation has been sponsored by bipartisan members of Congress. If you recall, Dr. Larry Bucshon, a member of the Committee on Energy and Commerce and Congressman James Comer, Chairman of the Committee on Oversight and Accountability, discussed this extensively and worked on extending it further. While ASIPP has spearheaded to make this a reality, numerous organizations have worked tirelessly led by AMA.
The only deficiency is that it is not yet permanent. We will continue to work on this issue.
LATEST UPDATE
Medicare Revises LCD – Facet Joint Interventions for Pain Management (L38773) with Coverage for Therapeutic Facet Joint Nerve Blocks
Medicare publishes revised LCD for Facet Joint Interventions for Pain Management, providing coverage for therapeutic facet joint nerve blocks.
As you know, the LCD which went into effect on 5/2/2021, limited its coverage to intraarticular joint injections. When ASIPP became aware of this limited coverage, we began contacting Medicare to request a policy change to include therapeutic facet joint nerve blocks. After several correspondences, we were advised to file a reconsideration request. Our reconsideration request went through the appropriate channels and the LCD has been revised effective 7/7/2024, which includes medial branch blocks as a therapeutic procedure, along with the intraarticular injections.
Once again therapeutic facet joint injections or medial therapeutic facet joint nerve blocks are not covered unless there is justification in the documentation showing why radiofrequency neurotomy cannot be performed.
ASIPP was able to obtain this addition by presenting appropriate evidence with multiple systematic reviews as well as up-to-date literature. A presentation was also made by Dr. Laxmaiah Manchikanti and Dr. Amol Soin at CGS open meeting.
In addition to CGS, all MACs have either changed or are in the process of changing their policies. Please see the policy from CGS using the following link. https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=38773
Washington State Authority Health Care Authority Publishes Draft Findings Providing Coverage for Spinal Cord Stimulation
As some of you may know, Washington State Authority Health Care Authority has been considering coverage for spinal cord stimulation. Other states will be doing the same. ASIPP has been working on this for quite some time, along with multiple other organizations. Dr. Amol Soin and Dr. Chris Gharibo were intimately involved. Dr. Gharibo testified on our behalf in front of the Commission. Dr. Soin wrote the public comments. Overall, Washington State Authority Health Care Authority changed its policy, and the draft policy shows they are going to cover spinal cord stimulation for post lumbar laminectomy syndrome, non-surgical low back pain, and painful diabetic peripheral neuropathy, but not for complex regional pain syndrome.
Overall, this is very good, but we will have to overcome multiple limitations included in this, such as each patient undergoing the completion of a comprehensive cognitive behavioral therapy, chiropractic, or acupuncture, which seems to be impractical or extremely difficult to achieve. We are working on these issues, as well as with other organizations.
ASIPP congratulates all those involved in this great cause, which is largely moving in a positive manner. This is a big step forward considering that it was not covered at all.
Please find the Spinal Cord Stimulation DRAFT findings and decision: https://www.hca.wa.gov/assets/program/SCS-draft-findings-and-decision.pdf
Effective from April 1st, the Majority of MAC Will Follow Updated Guidelines for Trigger Point Injections
Effective from April 1st, the majority of MAC follows the above guidelines for Trigger Point injections.
Below are major points from the updated LCD:
• Frequency: No more than 3 TPI sessions will be reimbursed per rolling 12 months.
• Imaging guidance: The use of fluoroscopy or magnetic resonance imaging (MRI) guidance for the performance of TPI is not considered reasonable and necessary, The use of ultrasound guidance for the performance of TPI is considered investigational.
• Repeat TPI: Consistent pain relief from the most recent previous TPI lasting at least 6 weeks.
• With other Injections: It is not considered medically reasonable and necessary to perform multiple blocks (e.g., epidural steroid injection (ESI), sympathetic blocks, facet blocks, etc.) during the same session as TPI.
• Pain Scale: Documentation should be updated with the pre and post-pain scale.
Below are attachments for the updated LCDs:
Join the AMA or Renew Your Membership Today!
On behalf of the Board of Directors of the American Society of Interventional Pain Physicians (ASIPP), we ask that you help IPM to maintain a voice in the AMA. Please join the AMA or renew your membership today.
ASIPP previously had two positions in the House of Delegates (HOD), however we just learned that in our 2024 review, we did not have enough ASIPP members on the AMA roster to keep our second seat. Consequently, we now have only one position.
However, it is now time for our 5-year review of our membership AMA match. The member list we send to the AMA every five years is the list they use each year for five years to determine our status. This means that if we fall below the minimum requirement, we stand to lose our only remaining seat.
For ASIPP to retain our seat, the AMA requires that 20% of ASIPP’s physician members also be members of the AMA. ASIPP must submit our member list no later than Monday, April 15. Because of this, we ask that you check your AMA status and renew or join TODAY.
Joining the AMA will strengthen our specialty’s representation at the national level through the AMA HOD the AMA’s policymaking body, and strengthen our ability to meet the challenges in health care today with thoughtful, well-organized responses to issues such as Medicare payment cuts, medical liability reform, etc.
Membership also gives you access to a broad range of practice management resources and award-winning publications, such as the Journal of the American Medical Association, AMNews, AMA Morning Rounds and the Archives journals.
Please support the critical activities of ASIPP by joining the AMA today. To join or renew the AMA, click on the following link: Join or Renew Here.
CMS And Optum to Provide Accelerated Payment Loans and CMS Urges Medicaid Managed Care Plans and Medicare Advantage Plans to Offer Similar Loans
As reported last week, there was a cyberattack on UnitedHealth Group’s subsidiary Change Healthcare. Change Healthcare started experiencing major problems Feb. 21 cutting providers off from payer reimbursements.
Due to lobbying from various groups including ASIPP, temporary loans for all providers including physicians have been arranged. If you recall, this was limited to only hospitals in the beginning.
On Saturday March 9, 2024, CMS issued the attached statement announcing that in addition to considering application for accelerated payments for Medicare Part A providers, application for advanced payments for Part B suppliers will also be considered.
CMS issued a Fact Sheet with additional detail on eligibility requirements, certification terms, and payment amounts.
All MACs will provide public information on how to submit a request for a Medicare accelerated or advanced payment on their website starting March 9, 2024.
CMS is also urging Medicaid Managed Care Plans and Medicare Advantage Plans to offer similar emergency payment loans to cope with Change Healthcare cyberattack.
In addition to the CMS program of accelerated payments, United Health Groups loan program administered through Optum Financial Services offers financial assistance to providers whose payer payment are processed through Changes EDI. The loan amount is based on average prior claims volume and how much the provider’s payment distributions have been affected. No interest or fees will be charged, but the funds must be repaid.
Overall, while this may help physicians who were excluded in the beginning, it may not be sufficient. Many practices are seeing that a mere fraction of the daily deposits are being given in the form of loans.
If you have any questions, contact your MAC, as well as Optum, your representative for United Health Group or Optum for assistance.
MORE ON Chane Healthcare Cyberattack can be found on the following websites:
MedScape – AMA – HHS – TechTarget – CMS
U.S. Congress Finally Reduced the Cut by Half 1.68% from 3.37% Effective March 9, 2024
In a federal budget deal struck to avoid a government shutdown, the House of Representatives has voted to reduce about half (1.68%) of the 2024 3.37% across-the-board physician pay cut that took effect in January. The Senate is expected to vote soon, and the President is expected to sign which will be effective March 9.
This essentially means Congress has again failed to stop in its entirety a pay cut that threatens Medicare patients’ access to high-quality physician care.
The cut continues to persist over 2% of sequester cuts totaling to 3.68%, on top of 4% from last year’s physician pay reduction. Unfortunately, as in contrast to prior years, this payment rate is not retroactive.
This was achieved due to enormous effort by all organizations, including ASIPP, with widespread support to block the 3.37% Medicare cuts for physician services on a permanent basis.
Our conversations with members of Congress show that they are looking at ways to create a permanent fix for these issues. We need to continue to place pressure on Congress for a permanent fix. The graph below shows 2024 Medicare payment updates prior to the 50% reduction of the cut as projected by AMA. The only change would be 1.68%. instead of 3.4%.
Officials Rush to Help Hospitals, Doctors Affected by Change Healthcare Hack
Federal officials and health-industry executives Tuesday said they were racing to help hospitals and health-care providers that are at risk of running out of cash after a cyberattack knocked out the nation’s largest processor of medical claims and put pressure on patient care.
The Department of Health and Human Services unveiled a strategy that encouraged private health plans to advance funding to the hardest-hit organizations and relax requirements that often slow the billing process, among other steps. The Centers for Medicare and Medicaid Services (CMS) said it would consider individual requests for accelerated payments, akin to those made during the coronavirus pandemic, recognizing that “hospitals may face significant cash flow problems from the unusual circumstances impacting hospitals’ operations.”
Aledade, the nation’s largest network of independent primary care practices, also announced that it would advance up to $100 million to its physician practices across the country.
Read More: https://ow.ly/2bpk50QOJG3
The Saga of Amniotic Tissue Intraarticular Injections
is Coming to an End
As you recall, ASIPP sent a news alert on October 29, 2020 focusing on Q codes and potentially fraudulent billing with intraarticular injections. ASIPP also sent a letter to Medicare MAC directors on November 3, 2020.
After the time of this alter, there have been incidences of fraud and abuse. Recently, a physician assistant went to trial in Fort Worth, TX and was convicted at this trial. Dr. Manchikanti provided the testimony for the Department of Justice highlighting the news alert from ASIPP.
The trial lasted 5 days. Subsequently, in less than 1 hour of deliberation, a jury convicted Ray Anthony Shoulders on all counts.
It is important to ASIPP and crucial to protect our physicians from fraud and abuse investigations, and at the same time, protect the Medicare program.
Important News Alert on Disastrous Reductions Due to a Computer Glitch for ASC Payments
On January 2nd, 2024, an ASIPP member from Texas brought to our attention a concerning issue, a 46.1% reduction in all ASC payments. This unexpected news prompted immediate action on our part. Acting swiftly, ASIPP and SIPMS reached out to CMS through the office of Cathy McMorris Rodgers, Chairman of the Energy and Commerce Committee, and CGS MAC Directors by ASIPP and SIPMS, seeking resolution.
CGS, led by Earl Berman, MD, promptly addressed the matter, successfully rectifying and adjusting the rates within 24 hours. All other MACs are still correcting.
Additionally, we want to inform you that a sample table has been generated for Kentucky’s McCracken County.
While Noridian, Novitas, NGS, Palmetto GBA, and WPS still reflect rates at 54% of the National Price, we intend to wait for 24 hours then contact them to expedite the resolution of this issue.
ASIPP UPDATES
ASIPP is pleased to announce the publication of the Comprehensive Evidence-Based Guidelines for Epidural Interventions in the Management of Chronic Spinal Pain. In preparation of the guidelines, an extensive literature review was performed. The 210-page guidelines contains 33 figures, 48 tables, 1,345 references and has 60 authors.
In addition to the review of multiple manuscripts in reference to utilization, expenditures, anatomical and pathophysiological considerations, pharmacological and harmful effects of drugs and procedures, for evidence synthesis, we have included 47 systematic reviews and 43 RCTs covering all epidural.
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ANNOUNCEMENTS
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We are pleased to invite you to the ASIPP DocMatter Community, an exclusive, private platform designed to connect ASIPP members in a collaborative and secure environment. Engage with peers, discuss clinical cases, share research, and stay informed on the latest in interventional pain management.
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Doctor Finder allows you to search for an ASIPP® Member Interventional Pain Physician anywhere in America by name or by location. It’s quick and easy.
Since this malpractice insurance program officially launched in November 2018, ASIPP has signed up hundreds of providers with an average savings of 30%. This is professional liability insurance tailored to our specialty and will stand up for us and defend our practices.
Curi is a full-service advisory firm that serves physicians and their practices. Their valued advice is grounded in your priorities and elevated in your outcomes. They are driven by a deep understanding of your specific circumstances in medicine, business, and life. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary risk management CME activities, click here.
PainExam is proud to announce that it now offers preparation for the ABIPP Pain Management Board Exam! In addition, PainExam has now collaborated with ASIPP to offer Virtual Learning programs.
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PainCast, the pain management network, has collected years worth of information on the history and processes of the pain management specialization and transformed it into a virtual library of videos, journals, articles, podcasts, and more – all at your fingertips.
Leading experts in their respective fields contributed chapters on specific topics to present a cogent and integrative understanding of the field of regenerative medicine as applicable for interventional pain physicians.
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This comprehensive review covers the full and latest array of interventional techniques for managing chronic pain and features new chapters covering challenges with opioid therapy, impact of COVID-19, and spinal interventional techniques.
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ASIPP has formed a partnership with Henry Schein and PedsPal, a national GPO that has a successful history of negotiating better prices on medical supplies and creating value added services for the independent physician.
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ASIPP is now offering our members the benefit of a unique revenue cycle management/billing service. We have received a tremendous amount of interest in the ASIPP billing and coding program.
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