Medicare to Give Diagnostic Imaging Procedures a Raise

Starting Jan. 1, 2017, Medicare will pay more for the professional component (PC) of certain diagnostic imaging procedures provided in conjunction with other procedures.

Medicare will lessen its multiple procedure payment reduction (MPPR) for the PC of these procedures from 25 percent to 5 percent of the Medicare Physician Fee Schedule amount.

The reduction applies to PC-only services, and the PC portion of global services, for procedures with a multiple surgery value of 4 in the fee schedule database. The bigger payment will affect 120 computed tomography, magnetic resonance imaging, and ultrasound procedures.

Currently, Medicare makes full payment for the PC of the highest-priced procedure and payment at 75 percent for the PC of each additional procedure when furnished by the same physician (or physician in the same group practice) to the same patient, in the same session on the same day.

Effective Jan. 1, 2017, Medicare will pay 95 percent of the fee schedule amount for the PC of each additional procedure furnished by the same physician (or physician in the same group practice) to the same patient, in the same session on the same day. (The MPPR on the technical component of imaging remains at 50 percent.) 

The example table below from the Centers for Medicare & Medicaid Services MLN Matters No. MM9647 summarizes current payment and the payment as of Jan. 1, 2017.

 Current Versus Revised Payments

 

Procedure 1

Procedure 2

Current Total Payment

Revised Total Payment

PC

$100

$80

$160 ($100 + (.75 x $80))

$176 ($100 +(.95 x $80)) 

TC

$500

$400

$700 ($500 + (.50 x $400))

$700 ($500 + (.50 x $400)) 

Global

$600

$480

$860 ($600 + (.75 x $80) + (.50 x $400))  

$876 ($600 + (.95 x $80) + (.50 x $400)) 

What else is new with Medicare for 2017? Find out in TMA’s popular annual Medicare update seminar. MACRA and Medicare: Get Clarity and Direction! will travel the state Oct. 25-Nov. 30. Find out what’s in store for 2017 and what’s coming under the Medicare Access and CHIP Reauthorization Act (MACRA). Register now. Also, visit TMA’s MACRA Resource Center

If you have questions about billing and coding, contact TMA reimbursement specialists at paymentadvocacy[at]texmed[dot]org for help, or call the TMA Knowledge Center at (800) 880-7955. 

Published Oct. 18, 2016

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Last Updated On

December 05, 2016

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