From CPT code changes to MedPAC’s latest recommendations, it’s been a rough ride for radiology.

They say there are two things we can all count on: death and taxes. For radiologists, add to that the ups and downs of reimbursement. It seems that no matter what other developments occur in medical imaging, there is always some reimbursement issue to contend with. Right now is no exception. There is no denying that since the beginning of the year, several new reimbursement challenges have arisen. However, there is some hopeful news about reimbursement as well.

Let’s begin with the challenges. We all know that as the Centers for Medicare and Medicaid Services (CMS) continues to look for efficiencies and savings, radiology is getting hit hard. In January 2011, radiologists were faced with CPT code changes. One significant change: Medicare combined CT abdomen and pelvis scans into a single code when both regions are examined in the same session. At the same time, according to the American College of Radiology (ACR), CMS further reduced the technical component values to the point where the bundled code is paid at nearly the same rate as the single region codes.

Clearly, the 2011 CPT code changes are having a significant impact on group practices and imaging centers. Pam Kassing, MPA, RCC, senior economic advisor at the ACR, estimates that reimbursement for CT abdomen/pelvis scans is down 25% for the professional component and approximately 55% to 60% for the technical component. To make matters worse, many experts expect to see more combined codes in the future, citing interventional radiology procedures as the next area of target. (To learn more about the economic impact of the 2011 CPT code changes, look for the feature story on this topic in our June issue.)

Another potential setback for radiologists came on April 7, 2011. In a 15 to 1 vote, the Medicare Payment Advisory Commission (MedPAC) recommended that CMS require prior authorization before select physicians could order advanced imaging tests. Specifically, the recommendation would apply to physicians who have a track record for ordering significantly more imaging studies than their peers. In addition, MedPAC recommended lower payments for successive imaging studies performed in the same session.

The Medical Imaging and Technology Alliance (MITA) was among the first to react to the news, criticizing the commission’s data. In a press release, MITA stated, “MedPAC continues to rely on out-of-date data to reach inaccurate conclusions regarding the use of life-saving advanced medical imaging services. Today, while MedPAC finally admitted that imaging utilization is flat, they still approved recommendations to further cut reimbursements to imaging procedures that have experienced significant cuts during the last five years and already face added cuts over the next few years.”

Reimbursement, it seems, will always be a rollercoaster ride for radiologists. But on the upside, some procedures are seeing improvements in reimbursement. Recently, for example, a new component of the National Oncologic PET Registry was opened to allow for NaF-PET scans to be reimbursed by CMS, under its coverage with evidence development program. It’s only a first step toward full CMS reimbursement for NaF-PET bone scans, but an important one nonetheless. (To learn more, see our Regulatory Watch column, page 8.)

Then there is the recent news concerning virtual colonoscopy. According to a study in the April issue of the Journal of the American College of Radiology, the utilization of diagnostic CT colonography by Medicare fee-for-service beneficiaries has tripled between 2005 and 2008. According to the authors, “Despite perceptions that new technology tracking codes are not payable, more than half of all examinations are now reimbursed by Medicare. Coverage varies regionally but overall is improving annually, setting the stage for expanded patient access.”

So while many in the industry say fasten your seat belts, there are more cuts to come, every now and then there is some good news around the bend.

Marianne Matthews

Marianne Matthews