Medicaid Reimbursement Delayed For New CT Abdomen and CT Pelvis CPT Codes

In the October 29, 2010 ADVOCATE eNews update, we informed providers of CPT coding changes for 2011, including codes for combining most CT abdomen and pelvis procedures:

· 74176 computed tomography, abdomen and pelvis; without contrast material
· 74177 computed tomography, abdomen and pelvis; with contrast material(s)
· 74178 computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions

The 2011 Medicare fee schedule reduced the professional and global reimbursement for the combined CT abdomen and pelvis procedures by approximately 28% and 45%, respectively. This has led to a significant reduction in top line revenue for radiology practices nationwide.

Adding insult to injury, many state Medicaid carriers have not made the necessary modifications to their systems to process and pay the new codes, causing the claim submissions to be denied. Texas Medicaid has confirmed that their system will not be updated with the new CPT codes until March 31, 2011. Medicaid of West Virginia is in the process of updating their system. Indiana Medicaid is updating their system and has admitted a significant backlog in processing these claims. Ohio Medicaid has confirmed processing issues resulting in Modifier denials for these codes. MediCal is also experiencing processing delays.

These carriers are updating their systems to process and pay the claims. Once the system modifications are complete all carriers have indicated that they will reprocess all submitted claims.

ADVOCATE will continue to monitor these and all payors, and update you with any new information.

With best regards,
Amanda Hecimovich
Financial Analyst