News | Cardiovascular Business | July 19, 2017

Comparison of CMS Reimbursements in Cardiac Imaging Between 2017 and 2018

SCCT comparison chart shows differences in 2018 proposed rates from CMS

Cardiac CT scan showing plaque and calcification in the coronary arteries, from a Toshiba CT scanner

July 19, 2017 — The Society of Cardiovascular Computed Tomography (SCCT) created a reimbursement fee chart for cardiac imaging showing various reimbursements for cardiac CT, MRI, echocardiography and SPECT perfusion. It breaks down the differences in payments between 2017 and what is being proposed by the Centers of Medicare and Medicaid Services (CMS) for 2018.

The chart can be accessed at http://scct.org/?page=2017ReimbursementCha

The chart includes the current procedural terminology (CPT) codes, and sections for the Medicare Physician Fee Schedule (MPFS) professional component (PC) and technical component (TC) payment for 2017; proposed MPFS PC and TC for 2018; OPPS TC payment in 2017 and the proposed OPPS TC payments for 2018. 

Payment Rates for Non-Excepted Off-campus Provider-Based Hospital Departments Paid Under the MPFS

Statute requires that certain items and services furnished by off-campus hospital outpatient provider-based departments be no longer paid under the Hospital Outpatient Prospective Payment System (OPPS) beginning January 1, 2017. For Calendar Year (CY) 2017, CMS finalized the MPFS as the applicable payment system for most of these items and services.

For CY 2018, CMS is proposing to reduce current MPFS payment rates for these items and services by 50 percent. CMS currently pays for these services under the MPFS based on a percentage of the OPPS payment rate. The proposal would change the MPFS payment rates for these services from 50 percent of the OPPS payment rate to 25 percent of the OPPS rate. CMS believes that this adjustment will encourage competition between hospitals and physician practices by promoting greater payment alignment.

2018 Hospital Outpatient Prospective Payment System (OPPS) Proposed Rule Overview

 

Restructuring of Imaging Ambulatory Payment Classification (APC) Groups

For 2017, CMS implemented a significant restructuring of the imaging Ambulatory Payment Classification groups, resulting in the consolidation of such groups from 17 in 2016 to seven imaging APCs for 2017.  CMS stated the purpose of this restructuring was to more adequately reflect resource costs and clinical characteristics of services assigned to the various APCs.  This restructuring translated to a negative impact on technical component (TC) reimbursement for many imaging procedures.   However, cardiac CT services saw an increase of approximately $30 under this restructuring.  For 2018, CMS proposes to add an additional imaging APC – Level 5 Imaging without contrast - for low volume, high cost services.  Preliminary review indicates the TC of CPT codes 75572, 75573 and 75574, would be cut by $30 under the proposed rule for 2018.  Please see the attached reimbursement chart for effects of the proposed rules on professional and technical component reimbursement for cardiac CT services.

Read the related article "SCAI Highlights News from Medicare Trustees Report and 2018 Medicare Physician Fee Schedule"
 

for more information: scct.org

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