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Prior Authorization for Facet Joint Interventions Would Restrict Timely Access to Medically Necessary Services

Sep 12, 2022, 12:00 PM by ASRA Pain Medicine

The Centers for Medicare and Medicaid Services (CMS) has proposed in its 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule to expand the hospital outpatient department (OPD) prior authorization process to include facet joint interventions.

ASRA Pain Medicine strongly opposes the proposed addition of facet joint interventions to the OPD prior authorization process, and further urges CMS to halt its overreliance on prior authorization for OPD procedures, instead pursuing other, more targeted and less burdensome options for curbing inappropriate utilization.

In a letter to CMS, ASRA Pain Medicine argued against the burden of administrative paperwork in addition to the larger concern about patients receiving care in a timely manner. Evidence indicates that prior authorization often leads to treatment abandonment, an unfortunate consequence of the effort to provide a safe and effective, non-opioid treatment to patients. ASRA Pain Medicine urged CMS to consider other strategies to address overutilization such as limiting prior authorization to outlier providers or those with high error rates.

Furthermore, if the prior authorization requirement sticks, ASRA Pain Medicine urges CMS to use board-certified pain medicine specialists to review these requests for facet joint injection interventions.

ASRA Pain Medicine advocates on behalf of the entire pain medicine community to promote safe, effective, and medically appropriate care for all patients.

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