How Medicare fee schedule changes will affect radiology

By Richard Morris, AuntMinnie.com contributing writer

September 17, 2018 -- Medicare is constantly on the lookout for procedure codes that it feels do not reflect the current cost or complexity of practice. The annual Medicare Physician Fee Schedule (MPFS) rule modifies many codes, with varying degrees of effect for radiology practices.

Richard Morris
Richard Morris.

Although the U.S. Centers for Medicare and Medicaid Services (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, the placement of peripherally inserted central catheter (PICC) lines is an important procedure for interventional radiologists, and it is facing a 57% decrease.

We present here some of the largest 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.

No. of procedures with changes
  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 reduced reimbursement than an increase. In the professional component list, eight procedures face a decrease of 16% to 20%, although half of these are ophthalmologic exams that are performed infrequently. The others are spine and neck x-rays, as shown below.

Select procedures with decrease of 16%-20%
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 global codes are proposed to be cut by 10% to 20% for 2019. Again, some are ophthalmologic exams, but quite a few CT and MRI procedures are included as well.

Select procedures with decrease of 10%-20%
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, 16 professional component procedures and 50 global procedures could increase by 10% or more. Notice, however, that some procedures with large global fee increases had decreases for the professional component. Some highlights are listed below.

Select procedures with increase of at least 10%
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%
Sacroiliac joints x-ray <3 views 72200 32.2% 21.4%
Sacroiliac 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 (IR) 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 increase by 1% or more while 232 will decrease by 1% or more. Here are some examples at the far ends of that spectrum.

Select IR procedures with changes
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.

Richard Morris is the director of value-based strategy for Healthcare Administrative Partners.

The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.


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