We wanted to provide you with an update from the NANS Advocacy and Policy Committee regarding an update in spinal cord stimulation (SCS) coverage for workers’ compensation cases in New York. Through extensive efforts by our industry partners and local members advocating for neuromodulation therapies, reimbursement issues related to SCS in New York Workers’ Compensation and Medicaid Programs have been significantly improved. As I am sure many of you were aware, the prior reimbursement levels paid less than the actual costs of a SCS implant with the purchased implanted equipment.
After extensive efforts and nearly 3 years of working with New York state, the issues related to SCS implantation in New York have been markedly improved. Physicians and industry worked together to provide an explanation and a methodological solution to the appropriate agencies in New York as it relates to SCS implantation surgery. After several years of hard work with government agencies in New York, we are pleased to report that SCS payment facility rates in New York State Medicaid and Workers’ Compensation will increase by 33% for 2019. Effective January 1, 2019, the SCS implantable pulse generator (IPG) insertion procedure facility payment for workers’ compensation increased from $18,580 to $24,750. In addition, the facility payment for SCS IPG implants within New York Medicaid increased from $12,387 to $16,500. We hope these payment increases improve access for patients who would benefit from the therapy in these state programs.
Please reach out if you have additional questions or need additional information.
The NANS Advocacy and Policy Committee
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