ACloserLook Reimbursement Issues in Diagnostic Imaging

Removal of Restrictive Criteria for Low Osmolar Contrast Media (LOCM) in the Physician Office and Clinical Settings

The Centers for Medicare and Medicaid Services (CMS) advised in the November 15, 2004 Medicare Part B Physician Fee Schedule Final Rule that they were eliminating the restrictive criteria for use of LOCM in the physician office and freestanding clinical settings. CMS, however, failed to publish a transmittal instructing carriers to acknowledge the change. Consequently, many carriers ignored the final rule and continued to restrict payment for LOCM. On July 29, 2005, CMS released claims transmittal 627 to resolve the inconsistent payment practice for LOCM.
For more information, visit:
http://www.cms.hhs.gov/manuals/
pm_trans/R627CP.pdf

Healthcare Common Procedural Coding System (HCPCS) Codes for Radiopharmaceuticals Used with Positron Emission Tomography (PET)

On July 29, 2005, CMS also released claims transmittal 628. This transmittal updates chapter 13, section 60, of the CMS claims processing manual. The update includes the addition of the HCPCS codes for radiopharmaceutical agents that should be billed with PET services performed on or after January 28, 2005.
For more information, visit:
http://www.cms.hhs.gov/manuals/
pm_trans/R628CP.pdf


Competitive Acquisition Program (CAP) Interim Final Rule

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 revised the “incident to” physician services provision (section 1861 (s) (2) (A)) of the Social Security Act. This revision permits payment of “incident to” drugs under the CAP. Radiopharmaceuticals and contrast agents are excluded from the CAP at this time. CMS published the CAP interim final rule in the July 6, 2005 federal register.
For more information, visit: http://a257.g.akamaitech.net/7/257/2422/
01jan20051800/edocket.access.gpo.gov/2005/pdf/
05-12938.pdf

Average Sales Price (ASP) Third Quarter Payment File

CMS released the third quarter ASP file on June 20, 2005. Updated payment rates for contrast agents are listed on this file.
For more information, visit: http://www.cms.hhs.gov/providers/drugs/asp.asp

2006 Proposed Rule for the Hospital Outpatient Prospective Payment System

CMS published the 2006 proposed HOPPS rule in the Monday July 25, 2005 Federal Register. The proposed rule brings a significant number of changes for radiopharmaceuticals, contrast agents, and imaging procedures. CMS proposes to reduce payment by 50% for certain multiple diagnostic imaging procedures within a “family” of procedures within the ultrasound, CT, CTA, MRI, and MRA modalities. This change is consistent with a proposal in the MedPAC report to Congress on the growth in spending on medical imaging procedures.

CMS is proposing to reimburse contrast agents based on ASP in the hospital outpatient setting. Radiopharmaceuticals that are separately payable in CY 2006 would be reimbursed per a temporary one-year policy based on a hospital’s charge for each radiopharmaceutical adjusted to cost.
For more information, visit: http://www.cms.hhs.gov/providerupdate/regs/
cms1501P.pdf

Category III Current Procedural Terminology (CPT) Codes for Cardiac Computed Tomography Angiography (CCTA)

The American Medical Association (AMA) introduced category III codes for CCTA on July 1, 2005. The codes are scheduled for implementation in January of 2006. Category III codes are temporary codes listed in the CPT manual as emerging technology, services, and procedures. Category III codes are intended to be used for data collection purposes to substantiate widespread usage. These codes are usually not referred to the Relative Value Scale Update Committee (RUC) for valuation. Payment for these services/procedures is based on the policies of payers not on a yearly fee schedule based on relative value units.
For more information, visit:
http://www.ama-assn.org/ama/pub/category/
3885.html#schedule3

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