HAP Radiology Billing and Coding Blog

How the Proposed Medicare Fee Schedule Changes Will Impact Radiology Practices

Posted: By Sandy Coffta on August 28, 2018

How the Proposed Medicare Fee Schedule Changes Will Impact Radiology Practices Healthcare Administrative PartnersCMS, 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

Change of less than 1%

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%)

MRA Neck w/wo

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%

MRA Upper Extremity w/wo

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%)

Fine Needle Aspiration w/o imaging

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.

 

Related Articles:

 

How Can Your Radiology Practice Maximize Its MIPS Score?

 

Using patient education to expedite payments in hospital-based radiology

 

What the MPFS Proposed Rule for 2019 Means for Radiologists

 

Get free expert advice on radiology RCM

 

Topics: radiology reimbursement, interventional radiology, MPFS, radiology

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