CMS Raises SPECT, Cardiac CT Reimbursement

 

May 10, 2010

May 10, 2010 - The Centers for Medicare and Medicaid Services (CMS) just released a technical correction to the 2010 Medicare Physician Fee Schedule, which results in payment increases for myocardial perfusion imaging (MPI), cardiac computed tomography (CT), and cardiac catheterization codes.

These payments are retroactive to Jan. 1, 2010. The correction notice also includes a minor increase in the Medicare conversion factor from 36.066 to 36.0791, effective June through December 2010.

The corrections to MPI and CT codes address errors made in incorporating recommendations from the American Medical Association/Specialty Society Relative Value Scale Update Committee, or RUC, on direct practice expenses, such as medical supplies and equipment time, for these services. The errors included incorrect practice expense values for CPT codes 75571–75574 and 78451–78454. The corrected national average payment for 78452, single photon emission computed tomography (SPECT) MPI is $439, compared to the $379 published in the November final rule.

The American Society of Nuclear Cardiology (ASNC), the Society of Nuclear Medicine (SNM) and the American Medical Association (AMA) identified the errors in the SPECT codes. The Society of Cardiovascular Computed Tomography (SCCT) and the American College of Cardiology (ACC) worked with CMS to correct errors in the cardiac CT codes.

The correction notice also includes changes to malpractice relative value units (RVU) for cardiac catheterization services. In the final rule for the 2010 Medicare Physician Fee Schedule, CMS agreed with ACC, the Society for Cardiovascular Angiography and Interventions (SCAI), and the AMA that cardiac cath services should be assigned malpractice RVUs based on the higher surgical risk factor. However, the published RVUs and payment rates did not correctly reflect that policy change. With this notice, CMS has corrected its error.

The payment changes reflect the higher risk associated with invasive procedures. Therefore, there will be an increase from $235 to $253 for 93510-26, the professional component for left heart catheterization.

For more information: www.acc.org