Consolidated Appropriations Act: Two Victories for Radiology

On December 18th, the Consolidated Appropriations Act was passed by Congress and signed into law by President Obama.  This Act, which outlines discretionary spending for nearly every facet of government, includes two important victories for radiologists:

  1. The rollback of the professional component of the multiple procedure payment reduction (MPPR)
  2. The protection of mammography coverage for women aged 40-49

The American College of Radiology (ACR) applauded these two provisions in this recent Act as this has been a hard-fought victory for radiologists everywhere.  More details regarding the ACR’s reaction to these provisions can be found by click here.

A brief summary of these two provisions is outlined below:

MPPR Rollback – Medicare patients

Currently, CMS applies a 25% reduction to the professional component of any advanced imaging study (CT, MRI, Ultrasound or combination thereof) performed on the same patient on the same day by the same radiology group.

This new legislation will decrease the reduction from 25% to 5% starting in the calendar year 2017.  Again, this change impacts the interpretation of these advanced imaging studies (the professional component).

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Mammography Coverage Protection – all insurers

Currently, the Affordable Care Act requires insurers to cover procedures given a grade of “B” or higher by the U.S. Preventative Services Task Force (USPSTF).  The USPSTF gave annual routine screening mammography exams for women aged 40-49 a grade of a “C”; a “B” grade was given for screening mammography exams every two years for women in this age group.  Because of this grading system, private insurers would not have been required to cover annual screening mammograms for women under the age of 50.

The Consolidated Appropriations Act includes language that provides for mandatory insurance coverage for women aged 40 and over to obtain an annual screening mammography exam with no copay.  The Act delays implementation of the USPSTF recommendations for women aged 40-49 for two years.

As always, ADVOCATE will work to keep you up to date on all new developments and changes to the radiology industry.

Best regards,
Wendy Driscoll, MBA
Senior Client Manager