UPCOMING MEETINGS & COURSES

Fellows Webinar

WEBINAR REGISTRATION  ]

*In support of pain management residents and fellows, this ASIPP webinar is complimentary 

Medicare Target Probe and Educate Audits Webinar
Documentation, Coding, Compliance, and Practice Management and Controlled Substance Management Virtual Review Courses
ASIPP Annual Meeting 2023

ASIPP PODCASTS

Here are some of the available ASIPP® Podcasts:

  • 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

[ SELECT MORE ASIPP® PODCASTS ]

ASIPP MEMBERSHIP

Join ASIPP. Your Voice For Interventional Pain Management

CMS Releases Final Payment Schedules for 2023: Physician Payment Rates, Ambulatory Surgery Center Rates, and Hospital Outpatient Department Rates

Most of the final rates remained close to the proposed rates. The physician payment rate changed from a 4.4% cut to 4.5% cut. Consequently, we have identified additional reductions. Here are the sample pages for fee schedules:

To view the entire fee schedule go to the ASIPP members only website.

[ READ MORE

ASIPP Important Updates

Proposed LCD Released for Sacroiliac Joint Injections and Procedures

Update October 14, 2022: A letter has been sent today to the Medical Directors of multiple MACs regarding Proposed LCD-Sacroiliac Joint Injections and Procedures. Please look over the letter here.

On March 10, 2022, a multidisciplinary evidentiary CAC meeting was held with collaboration of multiple MACs. To date, NGS, Noridian, WPS and Palmetto have posted their proposed LCDs. CGS has announced an open CAC meeting, but we are awaiting on their LCD to be posted. First Coast and Novitas did not participate in the evidence development. Consequently, we are not sure if they will be posting a proposed LCD or not.

There are various dates for comment periods, with Palmetto having the first comment period closing date of Oct. 15, 2022. Please look over the LCD

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Anesthesia for Pain Management Procedures: CGS Confirms the Message ASIPP has been Giving Membership

ASIPP has been working on the issues concerning anesthesia for pain management procedures for a long time.

In the September 20, 2022 CGS News Publication, “Anesthesia for Pain Management Procedures,” CGS confirms the message ASIPP has been giving our membership:

Mild sedation is acceptable for all interventional procedures. Monitored anesthesia care is acceptable for radiofrequency neurotomy procedures. Otherwise, claims billed with moderate or deep sedation, general anesthesia, or MAC during a pain management procedure, other than radiofrequency, will be denied. Note: The entire claim will be denied—not just the sedation claim.

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United Healthcare Revises Epidural Injection Policy from 3 to 4 per Year, Based on the ASIPP Recommendation

Important news! United Healthcare’s new policy reverses the previous policy with a limit of three (3) epidural injections to the ASIPP recommendation of four (4) procedures per year. 

As you know, ASIPP has resolutely advocated for the change in the policy on epidural injection limits of three (3) per year through evidence-based presentations and communication. We first sent a letter on June 21, and they responded on June 27. Since then, we have continued with multiple other correspondences. Consequently, they published the new policy effective November 1, 2022, which now provides coverage for four (4) procedures.

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Bill to Avert Impending Conversion Factor with Cuts of 4.4% in 2023 to be Introduced

Great news! Representatives Larry Bucshon (R-Ind.) and Ami Bera (D-Calif.), are introducing a bill that would prevent a 4.4 percent Medicare physician fee payment cut from taking effect on January 1, 2023, through the introduction of the Medicare Access and CHIP Reauthorization Act of 2015 and associated payment mechanism.

This is the bill we have been requesting from members of the Congress to introduce for some time for the last few months. ASIPP has supported this and ASIPP members have sent over 5,000 letters to Members of the Congress to date.

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Alarming Payment Schedule for Physicians, ASC, and HOPD Rules

Once again, physician payment, as well as ASC and HOPD rules, are out. The most alarming is physician payment, followed by ASC and HOPD rules. The rules show reductions of 4.4% in the conversion factor even though the makeup was only 3% during last year. In addition to this, we must add, as we have been repeatedly saying, a total of 6% leading to 10.4%. With 9% inflation, we are looking for physician payment cuts of 20%.

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Onerous 10.4% Cut is Coming for Physicians, Compounded by an Escalating 9% Inflation, Equaling a 20% Cut: Act Now! Your Survival is at Stake

CMS has published the 2023 Physician Fee Schedule and it is worse than we expected. The conversion factor has been reduced by 4.4%. It will be reduced from $34.61 to $33.08, a decrease of $1.53. This will be added to the 2% sequester cut from ACA and 4% statutory PAYGO from the American Rescue Plan Act. This is equal to nearly a 20% cut when you combine this with inflation. Unless Congress acts, the total expected cuts are 10.4% from 2022, and 9.75% from 2021, starting January 2023. 

We encourage every ASIPP member to join us in the effort to contact every member of Congress. You can start by contacting the Senators and Representatives of your
district. It is essential that we act soon and participate in meetings with members of our Congress, as well as start a letter campaign involving physicians, providers, nurses, staff, and most importantly, the patients.

Please see the fact sheet (FACT SHEET) and sample
letters (SAMPLE PHYSICIAN LETTER) (SAMPLE PATIENT LETTER).

Link to submit patient letters: https://www.votervoice.net/ASIPP/campaigns/96404/respond

Link to submit physician letter: https://www.votervoice.net/ASIPP/Campaigns/96405/Respond

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United Healthcare Update on Recent Publication of Medical Policy for Epidural Steroid Injections for Spinal Pain 

ASIPP received a response letter from United Healthcare addressing our letter to them regarding the recent publication of medical policy for epidural steroid injections for spinal pain – Policy Number: 2022T0616D.

They are reviewing their policy and we ASIPP will continue to correspond with Untied Healthcare regarding their upcoming draft.

See our June 21 letter to United Healthcare and their June 27, 2022 response letter to us.

Additionally, on July 14 we contacted Centene on two clinical policies: Caudal or Interlaminar Epidural Steroid Injections and Selective Nerve Root Blocks and Transforaminal Epidural Steroid Injections. 

Read ASIPP letter to Centene

An Algorithmic Approach & Checklist to
Epidural Steroid Injections

After being made aware that several physicians are being audited, we are concerned that some members are having difficulty conforming to the LCDs and medical policies. In response, ASIPP is providing you with an algorithmic approach and a checklist.

Regardless of the opinions you hold and the evidence that exists, it is crucial to follow the LCDs. Whatever is quoted in the LCD or medical policy is final and we must abide by those.
See: https://asipp.org/icd-10-codes/

Any changes you believe are warranted should be presented for consideration through a redetermination process for LCDs or medical policies for private insurers or Medicaid. They can be submitted during the next cycle of revisions.

You can use this algorithmic approach whenever you see your patients by utilizing these checklists for each patient prior to performing epidural steroid injections and facet joint interventions.

Click here for Documentation, Indications, Limitations, Utilization, and a Checklist for Epidural Steroid Injections.

An Algorithmic Approach & Checklist to
Facet Joint Interventions

The algorithmic approach describes diagnostic block procedure, as well as therapeutic interventions.
Click here for Documentation, Indications, Therapeutic Facet Joint Interventions, Limitations, and a Checklist for Facet Joint Interventions.

IMPORTANT NEWS!
Percutaneous Adhesiolysis Is Now Covered in All States

Percutaneous adhesiolysis has faced multiple issues related to coverage in the past few years. Initially, Noridian issued a noncoverage decision, followed by Palmetto issuing an experimental procedure decision.

Since then, we have incorporated into discussions on epidural LCD. While it was discussed in epidural LCD, it was not issued in the final consideration. We continued our efforts for coverage of this procedure and general consensus was that they all will be covering as any other Medicare services in the absence of a particular policy. We continue to face questions with Palmetto and Noridian.

After many years of advocacy, we have finally succeeded in getting coverage for this important procedure in all states, including all Palmetto and Noridian states in the United States.

We are very grateful to the Multijurisdictional Committee that convened considering epidural injections on 2/11/2021 for considering percutaneous adhesiolysis. We are also grateful to the Medical Directors of Palmetto and Noridian MACs for their prompt response.

Enclosed, please see the letters written to Palmetto and Noridian and the responses from Palmetto and Noridian.

Read More…

Louisiana House Bill 941 is Tabled after ASIPP and LSIPP’s Opposition

The American Society of Interventional Pain Physicians (ASIPP) and Louisiana Society of Interventional Pain Physicians (LSIPP) actively opposed Louisiana HB 941 which would restrict access to minimally invasive spine procedures performed by appropriately trained interventional pain management physicians.

The bill would restrict access to care, prevent new minimally invasive techniques from being accessed in LA which are currently readily available across the country, and ultimately harm patient care by forcing patients to have much larger and more invasive procedures completed by surgical specialists who only seek to protect their financial well-being by restricting access only to themselves to complete more invasive procedures. 

Read more…

ASIPP, IPM, and Patient Response to the Proposed CDC Guidelines

The 2016 CDC opioid guidelines were aimed at primary care providers, but many state boards mandated them by law, resulting in tremendous needless suffering and exacerbating the illicit opioid epidemic with causation of needless deaths. These guidelines not only restrict opioid prescriptions, but also have restricted almost all interventional techniques to reduce access and sending patients to the streets for illicit opioids. With the new guidelines, these unintended consequences, including overdoses, deaths, and access limitations will continue.

The guidelines should call for a multidisciplinary approach to chronic pain that includes multiple modalities incorporating the role of interventional pain management for diagnosis and treatment.

Good News! Telehealth Services Extended Through December 2023

Telehealth services, including telephone only services, were added as an emergency at the onset of COVID with multiple efforts from ASIPP and other organizations. However, CMS has now extended this through 2023.

Telephone CPT codes (99212 -95, 99213 -95, 99214 -95, 99441, 99442, 99443) have been eliminated from the 2022 fee schedule effective December 31, 2021. However, the public health emergency (PHD) was later extended with a new effective date through April 17, 2022.

CMS has issued a new notification that:

All telehealth services temporarily added to the telehealth services list during the PHE will remain on the list through December 31, 2023. These services include those that would have been removed as of December 31, 2021.

This is great news. Consequently, we do not have to worry about for 2 more years.

To read more about this Public Health Emergency Declaration, go to https://www.phe.gov/Preparedness/legal/Pages/phedeclaration.aspx

Thank you again for your interest in ASIPP. We will continue to update you as we obtain information on these crucial issues.

Updated Information on the Nationwide LCD Policy for Epidural Procedures for Pain Management

CGS has released its final policy for epidural steroid injections for pain management has been released. This will be effective 12/5/2021. Please check your individual MACs.  Read more…

 

Public Health Emergency Covering Telephone Only Services Extended through January 17, 2022

The public health emergency (PHE) was set to expire on October 18, 2021. Secretary Becerra has once again renewed this PHE for a period of 90 days, which will extend the coverage for telephone only services until at least January 17, 2022. Currently, it is expected that HHS will continue to renew it declaration of the PHE every 90 days through the end of 2021 and will provide 60 days’ notice prior to ending it.

Our letter campaign is also trying to prevent cuts of 9.75% for physician payment and 6% for facility payment. To participate in the letter campaign and to read more about this issue by visiting the ASIPP Advocacy site at. https://asipp.org/advocacy/

CALL TO ACTION!

In January 2022, physician practices face the following Medicare financial hits:

1. Physician Payment Cuts
• The expiration of the congressionally enacted 3.75% temporary increase to the Medicare physician fee schedule conversion factor, which was set into place to avoid payment cuts associated with budget neutrality adjustment tied to PFS policy changes.
• The expiration of the current reprieve from the repeatedly extended 2% sequester stemming from the Budget Control Act of 2011. It appears that while Congress originally scheduled this policy to sunset in 2021, it will now continue into 2030.
• The Imposition of a 4% statutory PAYGO sequester resulting from passage of the American Rescue Plan Act, presumably extending for at least another 10 years.

2. Facility Payment Cuts
• Under the present status, it appears that ambulatory surgery centers and other facilities will be suffering with 2% cut from sequester extension and a 4% reduction with imposition of a 4% statutory PAYGO sequester resulting from passage of the Budget Control Act of 2011

3. Telephone Only Services
• CMS has eliminated coverage for telephone only services (CPT 99441-99443), effective December 20, 2021. 

Link to submit patient letters through VoterVoice: https://www.votervoice.net/ASIPP/campaigns/88591/respond

Link to submit physicians and staff letters through VoterVoice: https://www.votervoice.net/ASIPP/campaigns/88596/respond

[ Click here for more information and sample letters]

A proposed LCD on Epidural Procedures for Pain Management services was announced on June 10, 2021. This nationwide policy contains many onerous changes that will detrimentally affect patient access to care. ASIPP has written comment letters with detailed explanations of the issues and needed changes to each Medicare Contractor. Click to read more.

The Good, the Bad, and the Ugly of HOPD and ASC Proposed Rule for 2022

GOOD
Telehealth services are preserved through 2023 and evaluation management services are expanded.

BAD
Expiration of the congressionally enacted 3.75% temporary increase in Medicare physician fee schedule conversion factor, reducing the conversion factor by 3.75%.

UGLY
Addition of 6% cuts, 2% from 2011 of Obama era, and 4% from American Rescue Plan Act of 2021, totaling 6%.

UGLIER
It could get even uglier if Congress passes infrastructure bills as one unit or 2 units, which may add additional 4% or more to the cuts.

See Comment Letter on Proposed HOPD/ASC 2022 Fee Schedule

CMS Releases Proposed 2022 Physician Fee Schedule: The Good, the Bad, and the Ugly

GOOD
Telehealth services are preserved through 2023 and evaluation management services are expanded.

BAD
Expiration of the congressionally enacted 3.75% temporary increase in Medicare physician fee schedule conversion factor, reducing the conversion factor by 3.75%.

UGLY
Addition of 6% cuts, 2% from 2011 of Obama era, and 4% from American Rescue Plan Act of 2021, totaling 6%.

See Comment Letter to CMS on Proposed Physician Fee Schedule

Read more…

From the beginning of the Covid-19 pandemic to all the variants, keep up to date here on all the issues related to your practice. 

Click here to access ASIPP’s COVID-19 Resources. Here is a list of some of the articles found there:
1.
ASIPP Draft Guidance Document on COVID-19 Vaccine and Steroids

2. Good News About Telehealth and Payroll Protection Program

Audits of Medicare Payments for Spinal Pain Management Services

Medicare Part B covers various spinal pain management services including facet joint injections, facet joint denervation sessions, lumbar epidural injections, and trigger point injections. Medicare Part B also covers sedation administered during these pain management services. We will audit whether Medicare payments for spinal pain management services billed by physicians complied with Federal requirements. Expected Issue Date (FY) 2022

Click here for more information and related articles.

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.

[ READ MORE ]

ANNOUNCEMENTS

New Members Only Resource

2022 FEE SCHEDULES - 2023 PROPOSED

2023 Fee Schedules

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.

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.

Essentials of Regenerative Medicine in Interventional Pain Management is a book to bring concise, collective, and comprehensive information to interventional pain physicians practicing regenerative medicine with its applications in managing chronic pain.

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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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The American Society of Interventional Pain Physicians (ASIPP) is pleased to announce a partnership with Willow Risk Advisors to create an exclusive policy available to ASIPP members. In an effort to further increase value to its physician members, the American Society of Interventional Pain Physicians (ASIPP) has endorsed Willow Risk Advisors as their professional liability insurance broker.

[ READ MORE ]

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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