Liaison: Tiffany R. Hodges, MD

One of the top legislative priorities for neurosurgeons involves reforming utilization review practices such as prior authorization, step-therapy, and Medicare’s appropriate use criteria program for advanced diagnostic imaging. As neurosurgical oncologists, this directly impacts our patients when we order imaging for tumor surveillance, preoperative surgical planning, or for navigation purposes during tumor resection, as prior authorization frequently results in treatment delays. A major step forward is that the House Ways and Means Committee unanimously approved the Improving Seniors’ Access to Care Act, as amended (H.R. 8487). The legislation would go a long way to address these problems by streamlining and standardizing prior authorization in the Medicare Advantage program by, among other things:

• Establishing an electronic prior authorization process.
• Requiring the U.S. Department of Health & Human Services to establish a process for “real-time decisions” for items and services that are routinely approved.
• Improving transparency by requiring Medicare Advantage plans to report to the Centers for Medicare & Medicaid Services on the extent of their use of prior authorization and the rate of approvals or denials; and
• Encouraging plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.

Moreover, there is an update in neurosurgical oncology coding. You may have noticed that a Category I code now exists for LITT (laser interstitial thermal therapy), which became part of the 2022 CPT Book. The AANS/CNS Coding and Reimbursement Committee continues to work tirelessly to assist in LITT coverage efforts and potential MS-DRG Assignment for LITT.

With upcoming midterm elections, as well as a rapidly changing health care climate amidst a global pandemic, the Washington Committee will remain steadfast in engaging our policymakers on the issues that affect neurosurgeons and our patients. Members of the AANS/CNS Tumor Section are encouraged to communicate with Tiffany R. Hodges, MD, who serves as your tumor section liaison to bring issues or concerns to our Washington Committee. You can stay informed on health care policy topics by subscribing to Neurosurgery Blog at www.neurosurgeryblog.org and following the Washington Committee on Twitter @neurosurgery.  Finally, periodic updates are available via AANS and CNS publications and through presentations at neurosurgery meetings.