Final 2011 Medicare Physician Fee Schedule Contains Payment Reductions for Advanced Imaging Services

The Final 2011 Physician Fee Schedule includes three provisions that will effectively lower payments for certain diagnostic imaging services. First, as mandated by the Affordable Care Act, effective January 1, 2011, CMS will assign a 75 percent utilization rate assumption to CT and MRI equipment-an increase that has the effect of lowering the practice expense relative value units and, thus, payment for imaging services utilizing this equipment.
Second, CMS expanded the list of imaging services affected by this change in the utilization rate assumption to include CT angiography and MRI angiography services.
Finally, CMS also expanded the multiple procedure payment reduction (MPPR) to the technical component of 20 percent more imaging services than under current policy. Currently, as revised by the Affordable Care Act, the MPPR imposes a 50 percent payment reduction (up from 25 percent) on the second and any subsequent CT, MRI or ultrasound service furnished during the same session, on the same or a contiguous body part and involving the same imaging modality. Effective January 1, 2011, CMS will apply the MPPR to multiple CT, MRI and ultrasound services performed in the same session without regard to whether the subsequent images involve the same imaging modality or a contiguous body part.

ADVOCATE will continue to provide updates as they become available.

With best regards,
Kirk Reinitz, CPA