DEXA Reimbursement Slashed

On Wednesday, February 22, 2012, President Obama signed into law the Middle Class Tax Relief and Job Creation Act of 2012, postponing the scheduled 27% cut to Medicare payments to physicians until at least December 31, 2012. However, the new law did not extend Section 309 of the Temporary Payroll Tax Cut Continuation Act of 2011 containing special payment rates for bone mass measurement (DEXA). This omission has caused professional rates to drop from $11.00 to $9.00 and global rates to drop from $100.00 to $55.00.

Congress first cut DEXA payments in 2007, when it reduced Medicare payments for imaging services as part of the Deficit Reduction Act of 2005. Radiologists took another payment hit when the Centers for Medicare and Medicaid Services reduced payments for radiologists work involved in interpreting the results of a DEXA test. The cuts were phased in over time, but by the beginning of 2010, the average professional and global Medicare payment for DEXA had dropped from a high of about $11.00 to $9.00 and $140 to $62, respectively.

Under The Patient Protection and Affordable Care Act signed into law on March 23, 2010, along with modifications made by the Healthcare Education Affordability Reconciliation Act (collectively, the “Healthcare Reform Law”), DEXA payments were restored to 70% of the 2006 level, through the end of 2011, bringing them back up to nearly $100. At the end of last year, the increase was scheduled to expire, when Congress granted a 2-month reprieve by including DEXA in the Temporary Payroll Tax Cut Continuation Act of 2011, which also extended the 2011 Medicare physician fee schedule rates. However, the Middle Class Tax Relief and Job Creation Act of 2012, signed into onFebruary 22, 2012 did not extend Section 309 of the Temporary Payroll Tax Cut Continuation Act of 2011 containing special payment rates for (DEXA) allowing the rates to drop.

ADVOCATE will provide clients with detailed financial analysis where it is necessary to show the impact of the new DEXA fees.

Best regards,
Rohan Shah
Financial Analyst