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Medicare Coverage Advisory Committee

It may sometimes seem as if PT services are being singled out for scrutiny by payers, or that these services are being cut while other services are not. The information below released by CMS reports on an upcoming meeting of the Medicare Coverage Advisory Committee (MCAC). At that meeting the MCAC will be discussing whether Spinal Fusion should be a covered procedure under the Medicare program. We are not alone.

MCAC Meetings
11/30/2006 - Spinal Fusion for the Treatment of Low Back Pain Secondary to Lumbar Degenerative Disc Disease

Issue
The incidence of low back pain at some time in a person's lifetime in the U.S. population is reported to be as high as 90%. There are numerous causes of low back pain and men and women are equally afflicted. The degenerative changes that occur in the intervertebral disc in the spine are thought to be part of the normal process of aging and do not always lead to low back pain. Low back pain secondary to lumbar degenerative disc disease (DDD) can usually be successfully treated conservatively. However, when conservative treatment is not successful, surgical intervention becomes an option to relieve the pain associated with DDD.

Since DDD is associated with the aging process, this is an affliction that is well represented in the Medicare population. CMS has a significant interest in discussing the evidence for surgical interventions for lumbar degenerative disc disease, with a specific focus on spinal fusion for low back pain associated with lumbar DDD in the Medicare population.

The Medicare Coverage Advisory Committee (MCAC) will hear presentations and discuss evidence relative to indications for spinal fusion, clinical outcomes (including adverse events) and the persistence of outcomes over time, outcome measurement tools, and outcomes related to different surgical spinal fusion procedures, as well as, the generalizability of this evidence to the Medicare population.

Actions Taken
August 25, 2006

Federal Register notice is published announcing the Medicare Coverage Advisory Committee meeting on Thursday, November 30, 2006.

August 30, 2006

Posted Federal Register notice.

Federal Register Notice

Contact Information
Deirdre O'Connor
deirdre.oconnor@ cms.hhs.gov
1-410-786-3263