Supporting the Physiatrist, Strengthening the Specialty

On Wednesday November 19, several member experts in spasticity management, including Ryan Hafner, MD, FAAPMR,  Kimberly Heckert, MD, FAAPMR, Mary Beth Russell, DO, MS, FAAPMR, and Lauren Shapiro, MD, MPH, FAAPMR, met with leadership at First Coast Service Options and Novitas Solutions to address the list of ICD-10 diagnosis codes in the recently finalized Billing and Coding Article: Botulinum Toxins (A58423). Last month, AAPM&R expressed concern about lack of coverage for a range of patients with spasticity secondary to paralysis resulting from stroke, spinal cord injury, and other conditions not currently listed in the Billing and Coding Article. 

Our members had an extremely collaborative discussion with the Medicare Administrative Contractor (MAC) Medical Directors, working toward both a long-term and short-term solution to ensure coding options for these patients. Details regarding this discussion are included in this response from the MACs. In the coming weeks, the MACs will be working to implement an alternative coding pathway for these patients, with AAPM&R pursuing a long-term goal of new ICD-10 coding. Please note this response directs that “providers should continue performing these services and may either hold claims until the fix is implemented or submit them for reopening if denied prior to the system update.” AAPM&R will continue to keep members updated as we receive further updates from the MACs. 

First Coast and Novitas also expressed interest in collaborating with physiatry through their Carrier Advisory Committee (CAC) process, as described in their communication. Members who are interested in AAPM&R supporting a nomination to serve on a CAC should contact Health Policy staff at healthpolicy@aapmr.org. 

A huge thank you to the member leaders who joined the contractor meeting this week as well as those who have been working tirelessly on our LCD comments and advocacy on this issue since 2024!

On Wednesday November 19, several member experts in spasticity management, including Ryan Hafner, MD, FAAPMR,  Kimberly Heckert, MD, FAAPMR, Mary Beth Russell, DO, MS, FAAPMR, and Lauren Shapiro, MD, MPH, FAAPMR, met with leadership at First Coast Service Options and Novitas Solutions to address the list of ICD-10 diagnosis codes in the recently finalized Billing and Coding Article: Botulinum Toxins (A58423). Last month, AAPM&R expressed concern about lack of coverage for a range of patients with spasticity secondary to paralysis resulting from stroke, spinal cord injury, and other conditions not currently listed in the Billing and Coding Article. 

Our members had an extremely collaborative discussion with the Medicare Administrative Contractor (MAC) Medical Directors, working toward both a long-term and short-term solution to ensure coding options for these patients. Details regarding this discussion are included in this response from the MACs. In the coming weeks, the MACs will be working to implement an alternative coding pathway for these patients, with AAPM&R pursuing a long-term goal of new ICD-10 coding. Please note this response directs that “providers should continue performing these services and may either hold claims until the fix is implemented or submit them for reopening if denied prior to the system update.” AAPM&R will continue to keep members updated as we receive further updates from the MACs. 

First Coast and Novitas also expressed interest in collaborating with physiatry through their Carrier Advisory Committee (CAC) process, as described in their communication. Members who are interested in AAPM&R supporting a nomination to serve on a CAC should contact Health Policy staff at healthpolicy@aapmr.org. 

A huge thank you to the member leaders who joined the contractor meeting this week as well as those who have been working tirelessly on our LCD comments and advocacy on this issue since 2024!