Payments for Use of X-ray Equipment Further Reduced

Payments for Use of X-ray Equipment Further Reduced

Payment for outdated X-ray technology is reduced more each year. For 2018, the Centers for Medicare & Medicaid Services (CMS) is targeting computed radiography.

New Modifier Applies Reduction

Medicare Physician Fee Schedule (MPFS) and Outpatient Prospective Payment System (OPPS) payments for the technical component (TC) of X-ray services taken using computed radiography technology (cassette-based imaging which utilizes an imaging plate) will be reduced by 7 percent from Jan. 1, 2018, through Dec. 31, 2022. Beginning Jan. 1, 2023, the payment reduction goes up to 10 percent.

Claims for computed radiography services that are furnished for X-rays must include newly-created modifier FY Computed radiography services furnished.

History Repeating Itself

Last year, CMS created modifier FX X-ray taken using film. Beginning Jan. 1, 2017, claims paid under the MPFS for X-rays using film must include modifier FX, which applies a 20 percent payment reduction to the TC.

Medicare administrative contractors (MAC) will compare the OPPS facility and non-facility payment fields to the MPFS facility and non-facility amounts and use the lower amount to apply the reduction.

For claims billed with both modifiers FX and FY, Medicare administrative contractors will apply both reductions, if applicable. The modifier FY reduction will be applied after the modifier FX reduction.

Reductions may not be recouped from the Medicare patient.

Reduction Doesn’t Apply to Packaged Services

No reduction is made when these services are packaged in the payment of another item or service under the OPPS because no separate payment is made.


Sources:

MLN Matters® Number: MM10188

MLN Matters® Number: MM9727

Renee Dustman

Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
Renee Dustman

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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

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