In the final 2020 Medicare Physician Fee Schedule (MPFS), fee increases relevant to radiology overall outnumbered decreases.  However, many of those increases were insignificant changes of less than 1%.  There were 128 Professional Component (PC) codes decreased by more than 1%, with only 76 increased, while 430 Global codes increased by more than 1% and 346 Global codes decreased.  Here are the details:

Diagnostic Radiology

As we reported in our recent article Coding Changes That Will Impact Radiology Practices in 2020, there were not many major changes to coding for 2020.  The coding for Upper GI Tract exams saw some bundling and code revision, as follows:

The result of these changes is increased PC reimbursement for all exams, while the global reimbursement decreased for the basic exams without small intestine follow-through.  The revised code definitions include all scout abdominal radiographs and delayed images.

Similarly, new codes were introduced that change the reporting of tumor localization using SPECT and SPECT/CT.  There is no direct comparison between the new and old coding, as can be seen in the table that follows:

The following is a sample of the procedures that saw an increase or decrease of 10% or more:

Our recent article Coding Changes That Will Impact Radiology Practices in 2020 explains some of these, such as the colon and small intestine exams that were subject to the bundling of all pre- and post- exam imaging into the primary code.  The American College of Radiology (ACR) has prepared a detailed summary of the many changes in the Medicare payment provisions for 2020 that includes explanations for some of the major swings we have identified.

Interventional Radiology

Lumbar puncture coding was revised as we described in our coding article to include fluoroscopic or CT guidance in two new codes, leaving the previously existing codes to have additional codes added when MRI or ultrasound guidance is used.  Here is the result of those changes: 

* Includes fluoroscopic guidance 77003, previously added to the basic procedure code.

Both the diagnostic and therapeutic lumbar puncture procedures received healthy increases when performed with fluoroscopic guidance, while the use of MRI or ultrasound guidance produces lower reimbursement than in 2019. 

Breast biopsy procedures have also been reduced in the range of 4 – 6%, with the most common (19083 using ultrasound guidance) reduced 4.74%.  This could be significant to a practice that does a lot of these procedures.

The Impact on Your Practice

It should be noted that all fees quoted here are from the national Medicare fee schedule, before adjustment for geographic indices.  While the exact reimbursement amount will differ in your particular practice, the percentage changes should be close to what we have described.

CMS estimates that there will be little to no change in overall reimbursement to radiologists as a result of the 2020 Medicare Physician Fee Schedule Final Rule, and our research bears out that estimate. In a weighted-average composite compiled by Healthcare Administrative Partners, we found a 0.46% decrease in professional component reimbursement and a 0.49% increase in global reimbursement. These results depend on the mix of modalities and the volume performed for each procedure.  The final analysis for any individual practice will depend on its structure (hospital-based professional component vs. global imaging center billing) and its mix of modalities.

A volume-weighted analysis is the only way the actual result of all these changes can be evaluated for your individual practice.  This process involves gathering data from the previous year that shows the number of times each procedure code was billed for Medicare patients.  The procedure volumes are multiplied by the 2019 Medicare fee schedule rates in one column, and again by the 2020 Medicare fee schedule rates in another column.  Totaling each column will reveal the total practice revenue for the previous year and the reimbursement that the practice could expect in the current year assuming the volume of each procedure is unchanged.   The percentage increase or decrease can then be calculated. 

This is what a typical full-service practice might look like based on their volume of procedures:

The total percentage impact appears to be negligible in either case, but what if the imaging center (global billing) did not have PET in their facility?  The $33,170 increased revenue would be eliminated and the result would be a $100 decrease in reimbursement, or essentially no change.  Obviously, an MRI-only center will be facing a more significant decrease while a women's imaging center with mammography and ultrasound could expect an increase.

In our example hospital (professional component) the largest dollar impact will be in CT with a $22,887 decline in revenue because of its volume, even though the decrease is only 0.89%.  Note that global CT reimbursement will be increased slightly.

Conclusion

Understanding the annual changes in Medicare’s fee schedules is useful when analyzing areas where the practice’s revenue might be increasing or decreasing.  Many commercial payers base their fees on the Medicare table, although not all of them make exactly the same changes, or at the same time, as Medicare does.  The same volume-weighted analysis technique can be applied to commercial fee schedules, as well. 

Healthcare Administrative Partners will continue to keep you abreast of the Medicare payment system, and subscribing to this blog is the best way to get the most current information available.

Sandy Coffta is the Vice President of Client Services at Healthcare Administrative Partners.

Related Articles

What the January 2020 Update to the Medicare AUC/CDS Mandate Means for Radiologists

Coding Changes That Will Impact Radiology Practices In 2020

Get Ready for Changes to Radiology Billing in 2020

Follow HAP on LinkedIn

Follow HAP on Twitter
Like HAP on Facebook