The American Academy of Pain Medicine

Reimbursement News for Your Practice

AAPM, Six Other Pain-Related Organizations Collaborate to Create Open Dialogue with CMS for Decision on Thermal Intradiscal Pain Therapy Coverage

(08-19-08)  Recently the Centers for Medicare & Medicaid Services (CMS) posted a non-coverage determination for IDET (Intradiscal Electrothermal Therapy), a non-surgical alternative treatment for discogenic low back pain.   While a CPT code had been established, reimbursement had not.  Ultimately the agency concluded that "there is insufficient evidence to conclude that thermal intradiscal procedures (TIPs) will improve health outcomes in the Medicare population with low back pain."  

Obtaining reimbursement codes and valuation for pain treatment is a continuing focus for AAPM on behalf of its members.  As such, to help CMS better understand TIPs, including IDET, and the value of appropriate pain care to patients, AAPM participated in a joint response to CMS with AAPMR, ASA, ASIPP, ISIS, NASS and PASSOR.  This collaborative initiative began several months ago with AAPM, NASS, ISIS, and PASSOR discussing the importance of developing stronger interspecialty society communications.  This culminated in a meeting during the ISIS Annual Meeting in Las Vegas last month, where the four organizations determined that approaching CMS on the IDET issue-not so much as a means of reversing earlier decisions but rather to establish clearly with CMS the need for strong evidence-based decision making in evaluating the effectiveness of any procedure under consideration by CMS.  Subsequently, other organizations were asked to join in this initiative relating to IDET, including ASA, ASRA, and ASIPP, and a letter from the various organizations was transmitted to CMS.  

Following transmittal of the letter, and to continue the collective voice in this issue, ASIPP secured a meeting with CMS on August 14 that included several pain organizations. AAPM members Eduardo Fraifeld, MD and Todd Sitzman, MD were present via conference call.  The goal of the meeting was to better understand the agency's position, provide an evidence-based IDET patient case study, and with an eye to the future, give input into how scientists and practitioners in this field evaluate new pain care treatments.  

With its non-coverage determination, CMS raised the standard of evidence required that has not previously been seen for spine care and grouped IDET with all other TIPs.  The unified letter and group meeting pointed out that for IDET, which is merely one type of  TIP, selection criteria would likely limit its use to patients under 65.  During the August 14 meeting, the agency stressed that they will look at all future treatments with an increased level of evidence requirement, raising the standard for all new technologies. 

CMS will post its response to the letter and meeting with a final decision on reimbursement forthcoming.