CMS (Medicare) opens a National Coverage Determination (NCD) request to review coverage of the lumbar artificial disc
BY BARB PETERSON, SEPTEMBER 14, 2005
By Barb Peterson
Emerson Consultants, Inc.
[Editor's note: We welcome consultant Barb Peterson as a guest blogger. See her profile here.]
CMS (Medicare) has opened a National Coverage Determination (NCD) request to review coverage of the lumbar artificial intervertebral disc. CMS opened this review because of a request from Richard A. Deyo, MD, MPH, University of Washington, School of Medicine. Dr. Deyo's letter requested CMS not cover total discs due to of a lack of data in patients over the age of 60. Why should this be a concern for the spinal market? If CMS issues a national non-coverage decision, artificial lumbar discs will not be covered or reimbursed for any Medicare aged patients.
Not only will Medicare aged patients be affected by this NCD, but non-Medicare payers tend to follow CMS decisions. So, if CMS does issue a non-coverage decision, device companies will have an uphill battle to get all payers to cover and pay for artificial discs. Overturning a national non-coverage decision requires an enormous effort, published data, and years to succeed.
Physicians should be the ones making the final treatment choice for their patients and should be able to use a device if the patient is an appropriate candidate for the treatment. How can the orthopedic and physician community become involved and impact this decision? Medicare is currently accepting public comments to determine if there is adequate evidence for evaluating health outcomes of lumbar artificial intervertebral disc surgery in the Medicare population. Physicians, professional societies, and industry need to submit comments by September 16, 2005 to CMS with evidence related to this evaluation and request that no national coverage decision be made until further data is collected.
1. Email Niccole Corbin, DPM, MHA at: niccole.corbin@cms.gov,
2. Reference CAG-00292N (NCD number) and voice your concern.
3. Sent hard copies to:
Niccole Corbin, DPM, MHA and Jyme Schafer, MD, MPH
Centers for Medicare & Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244-1850
Barb Peterson
Emerson Consultants
