CMS, the Centers for Medicare and Medicaid Services, is constantly on the lookout for procedure codes that it feels do not reflect the current cost or complexity of practice in their valuation. The annual Medicare Physician Fee Schedule (MPFS) rule modifies many codes with varying degrees of impact to radiology practices.
Although CMS estimates no change for diagnostic and interventional radiology due to the 2019 MPFS Proposed Rule, there are large increases and decreases in individual codes. For example, PICC Line Placement is an important procedure for interventional radiologists and it is facing a 57% decrease. We present here some of the largest of the decreases and increases in the proposed rule so practices can evaluate for themselves what might happen next year.
Diagnostic Radiology
Here is a summary of the changes to radiology (70000-series) procedures in the 2019 MPFS Proposed Rule:
| Number of procedures with a: | Professional Component | Global | |
| Decrease of 1% or more | 201 | 213 | |
| Increase of 1% or more | 47 | 187 | |
|
342 | 150 | |
| Total Procedure Codes | 590 | 550 |
More procedures are proposed for decreased reimbursement than an increase. In the PC list, eight (8) procedures face a decrease of 16 – 20%, although half of these are ophthalmologic exams that are performed infrequently. The others are spine and neck x-rays, as follows:
| Description | CPT Code | 2018 Rate | 2019 Rate | Increase / (Decrease) |
| Neck Spine 4/5 views | 72050 | $16.20 | $12.98 | (19.9%) |
| L-2 Spine 4/> views | 72110 | $16.20 | $12.98 | (19.9%) |
| Neck Spine 6/> views | 72052 | $18.72 | $15.14 | (19.1%) |
| L-S Spine Bending | 72114 | $16.92 | $13.70 | (19.0%) |
Twenty-seven (27) global codes are proposed to be cut by 10-20% for 2019. Again, some are ophthalmologic exams, but quite a few CT and MRI’s are included as well:
| Description | CPT Code | 2018 Rate | 2019 Rate | Increase / (Decrease) | |
| MRA Head w/wo | 70546 | $493.19 | $414.53 | (15.9%) | |
|
70549 | $512.63 | $434.36 | (15.3%) | |
| CT Abdomen/pelvis | 74178 | $288.00 | $247.28 | (14.1%) | |
| CTA Lower Extremity | 73706 | $349.56 | $300.54 | (14.0%) | |
| CTA Abdominal Arteries | 75635 | $374.04 | $324.69 | (13.2%) | |
| CTA Heart w/3D imaging | 75574 | $373.68 | $324.69 | (13.1%) | |
| CT Colonography | 74262 | $380.88 | $331.90 | (12.9%) | |
| CT Heart w/3D congenital | 75573 | $381.60 | $332.62 | (12.8%) | |
| MRI Chest w/wo | 71552 | $572.03 | $504.77 | (11.8%) | |
| CTA Upper Extremity | 73206 | $334.08 | $296.21 | (11.3%) | |
| MRA Head w/contrast | 70545 | $314.28 | $279.72 | (11.0%) | |
| MRI Lower Extremity w/o | 73718 | $301.68 | $269.27 | (10.7%) |
On the positive side, there are sixteen (16) PC procedures and fifty (50) global procedures that could be increased by 10% or more. Notice, however, that some procedures with large global fee increases suffered decreases on the PC. Here are some of the highlights:
| Description | CPT Code | Professional Component | Global | |
| Spine x-ray 1 view | 72020 | 50.2% | 25.6% | |
| Elbow x-ray 2 views | 73070 | 48.0% | 14.4% | |
| Heel x-ray | 73650 | 43.7% | 11.8% | |
| Forearm x-ray | 73090 | 37.7% | 24.8% | |
| Elbow x-ray 3+ views | 73080 | 32.2% | 4.6% | |
| Sacrum tailbone x-ray | 72220 | 32.2% | 21.4% | |
| SI Joints x-ray <3 views | 72200 | 32.2% | 21.4% | |
| SI Joints x-ray 3+ views | 72202 | 18.7% | 13.0% | |
| CT for needle biopsy | 77012 | 28.4% | 22.0% | |
|
73225 | (0.7%) | 17.5% | |
| MRA Spine w/wo | 72159 | 0.5% | 17.5% | |
| DXA peripheral | 77081 | (6.3%) | 20.2% | |
|
Ultrasound AAA screening |
76706 | 0.1% | 19.5% | |
|
Ultrasound transrectal |
76872 | (3.0%) | 28.5% |
Interventional Radiology
Many interventional radiology procedures are coded outside the 70000-series of CPT codes. Of the 661 codes that are relevant to radiology, according to the American College of Radiology’s Impact Table, 255 will be increased by 1% or more while 232 will be decreased by 1% or more. Here are some examples at the far ends of that spectrum:
| Description | CPT Code | Increase / (Decrease) | |
| Insert PICC catheter < age 5 | 36569 | (61.3%) | |
| Insert PICC catheter age 5+ | 36568 | (57.2%) | |
|
10021 | (21.8%) | |
| Exchange Nephrostomy catheter | 50435 | 10.4% | |
| Cystoscopy | 52000 | 11.6% | |
| Injection for Cholangiogram | 47531 | 11.7% | |
| Removal of biliary drainage catheter | 47537 | 12.1% | |
| Replace PICC catheter | 36584 | 70.4% |
Conclusion
A huge increase or reduction for a procedure that is rarely done has little impact on the practice’s overall revenue but changes to high volume procedures have to be viewed more carefully. Some revision of the proposed procedure valuation changes can take place before the 2019 fee schedule is finalized in November. We will continue to monitor and report on significant events that will affect your practice. Subscribe to this blog for the latest information.
Sandy Coffta is the Vice President of Client Services at Healthcare Administrative Partners.
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