Multiple Procedure Reduction on the Technical Component ...

1 MLN Matters Number: SE0665 Revised Related Change Request (CR) #: N/A Related CR Release Date: N/A Effective Date: N/A Related CR Transmittal #: N/A Implementation Date: N/A Do you have your NPI? National Provider Identifiers (NPIs) will be required on claims sent on or after May 23, 2007. Every health care provider needs to get an NPI. Learn more about the NPI and how to apply for an NPI by visiting on the CMS website. Note: Note: This article was updated on October 10, 2012, to reflect current Web addresses. This article was also revised on March 11, 2011, to add a reference to MM7176, which is available at ,to remind providers that they must be accredited by January 1, 2012, in order to be reimbursed for these services that are performed after that date.

2 All other information is unchanged. Multiple Procedure Reduction on the Technical Component (TC) of Certain Diagnostic Imaging Procedures and Cap on the TC of Imaging Procedures Provider Types Affected Physicians and suppliers billing Medicare carriers for imaging supplies and services Provider Action Needed STOP Impact to You This special edition article provides details regarding the Centers for Medicare & Medicaid Services (CMS) revised policies for the payment of the Technical Component (TC) of imaging procedures. CAUTION What You Need to Know CMS has 1) modified the Multiple Procedure payment Reduction to the TC of certain diagnostic imaging procedures and 2) implemented a Procedure specific Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations.

3 This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. Page 1 of 28 MLN Matters Number: SE0665 Related Change Request Number: N/A Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations.

4 This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2006 American Medical Association. All rights reserved. Page 2 of 28 payment cap on the TC payment of imaging procedures effective January 1, 2007, as required by the Deficit Reduction Act of 2005.

5 GO What You Need to Do See the Background and Additional Information Sections of this article for further details regarding this change. Background CMS is implementing two provisions in 2007 affecting imaging services. First, CMS is modifying the Multiple Procedure payment Reduction on certain diagnostic imaging procedures implemented in 2006. Second, they are implementing a new provision of the Deficit Reduction Act of 2005 (DRA) which imposes a payment cap on most imaging procedures. (More information on the DRA is available at on the CMS website. More information on the fee schedule final rules is available at #TopOfPage on the CMS website).

6 The first CMS provision for 2007 addresses payment for certain Multiple diagnostic imaging procedures, with: A full payment for the first Procedure , but A 25 percent Reduction in the Technical Component (TC) payment for additional imaging procedures (furnished on contiguous body parts during the same session). This is a smaller Reduction than the 50 percent that had previously been proposed for 2007. Table 1 below in the Additional Information Section contains a list of procedures subject to the Multiple Procedure payment Reduction . The second CMS provision limits the TC payment for most imaging procedures paid under the Medicare Physician Fee Schedule (MPFS) to the amount paid under the outpatient prospective payment system (OPPS).

7 Table 2 below in the Additional Information Section contains a list of procedures subject to the OPPS payment cap. Both provisions apply to TC-only services and the TC of global services. The professional Component (PC) is paid in full for all procedures. For imaging services subject to both the Multiple imaging Reduction policy and the outpatient hospital cap, CMS is applying: First, the Multiple imaging adjustment, and Second, the outpatient cap. MLN Matters Number: SE0665 Related Change Request Number: N/A Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations.

8 This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2006 American Medical Association. All rights reserved. Page 3 of 28 Note: Medicare Carriers will display the outpatient cap fee on their web sites.

9 Additional Information If you have any questions, please contact your carrier at their toll-free number, which may be found on the CMS website at on the CMS website You may want to review MM6912 at , which announces that a new accreditation requirement for providing the Technical Component of diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging, such as positron emission tomography (PET), is being mailed to providers and suppliers. You may want to review MM6993 at ,which alerts providers that effective January 1, 2011, CMS is consolidating the 11 advanced imaging families into a single family.

10 Medicare will make full TC payment for the Procedure with the highest priced TC and 50 percent each for the TC of each additional Procedure on the same patient on the same day. Table 1 Diagnostic Imaging Services Subject to the Multiple Procedure Payment Reduction Diagnostic Imaging Services Family 1 Ultrasound (Chest/Abdomen/Pelvis - Non-Obstetrical 76604 Us exam, chest, b-scan 76700 Us exam, abdom, complete 76705 Echo exam of abdomen 76770 Us exam abdo back wall, comp 76775 Us exam abdo back wall, lim 76778 Us exam kidney transplant 76831 Echo exam, uterus 76856 Us exam, pelvic, complete 76857 Us exam, pelvic, limited Family 2 CT and CTA (Chest/Thorax/Abd/Pelvis))