CMS Increases SI Fusion Payment 27%

Medical device company SI-BONE, Inc. has announced that the Centers for Medicare and Medicaid Services (CMS) has updated the fee schedule utilized in reporting minimally invasive sacroiliac (SI) joint fusion procedures.

Beginning on January 1, 2020, the Medicare Physician Fee Schedule for CPT^® Code 27279 will increase the Work Relative Value Units (wRVUs) from 9.03 to 12.13.

The CPT code’s surgeon payment from Medicare will increase 27%, from $720 to $915. CMS arrived at this decision in part due to national surgeon reports and evidence that wRVUs regarding such procedures between the years 2015 and 2019. The reports indicated underestimated time as well as complexity of work required by physicians performing these procedures.

Santa Clara, California-based SI-BONE was founded in 2008 and specializes in musculoskeletal disorders of the sacropelvic region. The company pioneered minimally invasive sacroiliac (SI) joint fusion procedures and, today, is the market leader in this innovative procedure.

The iFuse Implant™ system has been in commercial use since 2009 and is indicated by the FDA for the treatment of conditions including sacroiliac joint dysfunction as a direct result of sacroiliac joint disruption and degenerative sacroiliitis. This includes incidents that develop as a result of pregnancy.

The system is also intended for use in sacroiliac fusion to support immobilization and stabilization of the sacroiliac joint in adult patients undergoing sacropelvic fixation during lumbar or thoracolumbar fusion.

Due to a body of over 75 peer-reviewed studies demonstrating safety, efficacy, affordability and the biomechanical benefits of the iFuse Implant, many private and government insurers cover SI joint fusion procedure exclusively when completed with the iFuse Implant System.

Jeffrey Dunn, president, CEO and chairman at SI-BONE stated, “Since the FDA clearance of iFuse, more than 40,000 procedures have been performed by 1,900 surgeons, helping patients with SI joint dysfunction experience significantly less pain and improved quality of life…We applaud this decision by CMS to increase the physician fee for CPT 27279 based on the greater work effort and intensity involved when performing these minimally invasive SI joint fusion procedures.”