August 9, 2006—The Centers for Medicare and Medicaid Services (CMS) released a fact sheet yesterday detailing proposed changes to payments for imaging services under the Medicare Physician Fee Schedule (MPFS) required by the Deficit Reduction Act of 2005 (DRA). Two provisions were introduced. The first addresses payment for multiple imaging procedures; the second addresses payment for the technical component of certain imaging services.
Under the first proposed change, CMS would maintain the current multiple imaging adjustment policy as established by the 2006 rule, which reimburses 75% of the cost to image a second contiguous region of the body. This reimbursement level was originally slated to drop to 50%, but CMS has reconsidered “in response to comments on the multiple imaging adjustment policy in the 2006 final rule, and in light of the cap imposed by the DRA.” CMS also proposes that the outpatient hospital cap imposed by the DRA be applied after the adjustment, resulting in higher payments than if the cap were applied first.
The second provision limits the payment amount under the MPFS to the outpatient department payment amount for the technical component of certain imaging services; under this proposed change, the physician fee schedule payment amount for furnishing certain imaging procedures would not exceed the amount paid to a hospital outpatient department.
—Cat Vasko
