HCR: Technical Component Reduction Effective July 1
A provision in the Patient Protection and Affordable Care Act of 2010, or Health Reform law, further reduces payment for the technical component (TC) of multiple diagnostic imaging procedures beginning July 1.
Medicare currently makes full payment for the TC of the highest priced imaging procedure and payment at 75 percent the Medicare Physician Fee Schedule (MPFS) for the TC of each additional imaging procedure when performed during the same session on the same day. Effective July 1, the policy stays the same but the payment for additional procedures in the same imaging family is reduced from 75 percent to 50 percent of the MPFS when performed during the same session on the same day.
The 25 percent Multiple Procedure Payment Reduction (MPPR) increase applies to TC-only services and the TC portion of global services performed in a single imaging session on contiguous body parts. Such services appear in the MPFS database with a multiple surgery value of “4.”
The Centers for Medicare & Medicaid Services (CMS) provides this example in a one-time notification:
“For example, the reduction would not apply to an MRI of the brain (CPT 70552) in code family 5 (MRI/MRA Head/Brain/Neck), when performed during the same session, on the same day, as an MRI of the neck and spine (CPT 72142) in code family 6 (MRI/MRA Spine).”
The MPPR does not apply to the professional component (PC) or to the PC portion of global services. Services not subject to this policy have a value indicator of “99” in the MPFS database.
The current and revised payments that go into effect July 1 are summarized below in the following example:
|Procedure 1||Procedure 2||Current Payment||Revised Payment|
Source: CMS Transmittal 694, Change Request (CR) 6965.