Multiple Diagnostic Imaging Procedures Pay More in 2017
- By Renee Dustman
- In Industry News
- August 26, 2016
- Comments Off on Multiple Diagnostic Imaging Procedures Pay More in 2017
Effective Jan. 1, 2017, Medicare administrative contractors (MACs) will reimburse physicians, providers, and clinical diagnostic laboratories considerably more for the professional component (PC) of certain diagnostic imaging procedures than in years past.
When Less is More
Since 2012, MACs make full payment for the PC of the highest-priced procedure, and apply a Multiple Procedure Payment Reduction (MPPR) of 25 percent for the PC of each additional procedure furnished to same patient, by the same physician (or physician group), in the same session, on the same day.
The Consolidated Appropriations Act of 2016 revised the MPPR for the PC of the second and subsequent procedures, lowering it from 25 percent to 5 percent of the Medicare Physician Fee Schedule (MPFS) amount.
This reduction applies to PC-only services and the PC portion of global services with a multiple surgery value of four (4) in the MPFS database, and furnished by physicians who have reassigned their billing rights to a Method II critical access hospital.
The MPPR on the technical component of multiple imaging services after the first remains at 50 percent.
Table 1: Current vs. Revised Payments
|
Procedure 1
|
Procedure 2
|
Current Total Payment
|
Revised Total Payment
|
|
|
PC
|
$100
|
$80
|
$160 ($100 + (.75 x $80))
|
$176 ($100 +(.95 x $80))
|
|
TC
|
$500
|
$400
|
$700 ($500 + (.50 x $400))
|
$700 ($500 + (.50 x $400))
|
|
Global
|
$600
|
$480
|
$860 ($600 + (.75 x $80) + (.50 x $400))
|
$876 ($600 + (.95 x $80) + (.50 x $400))
|
Source: MLN Matters® Number MM9647, Aug. 5, 2016
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