Cardiac imaging is scheduled for reimbursement cuts -- including a 36% hack at SPECT myocardial perfusion imaging (MPI) -- under the final Medicare Physician Fee Schedule (MPFS) for 2010.
The U.S. Centers for Medicare and Medicaid Services (CMS) released the new MPFS rates on October 30, with the agency for the most part cutting reimbursement for a variety of medical specialties including cardiac imaging.
On the plus side, the agency published base rates for cardiac CT angiography (CCTA), adding legitimacy to the procedure and making it easier for clinicians to get paid for CCTA exams. It also increased global reimbursement for cardiac PET by about 17%.
The new MPFS rates wield significant cuts in reimbursement for cardiac imaging, despite a wall of opposition from providers. At the top of the list is a 36% cut for SPECT myocardial perfusion (current procedural terminology [CPT] code 78452), as well as the following:
- 14% for the combined echo code (CPT 93306)
- 10% in 2010 for transthoracic echocardiography with spectral and color Doppler (CPT 93306)
- 5% for electrocardiography (CPT 93000)
Additional cuts will be implemented each year for four years, according to the American Society of Echocardiography (ASE).
"All cardiovascular imaging will undergo drastic Medicare payment reductions in 2010 as the result of the final rule," ASE said in a statement. "SPECT myocardial perfusion will be the hardest hit, with a 36% reduction in 2010, as the result of CMS' decision to bundle add-on codes into the primary procedure and to implement the entire reduction in one year, rather than phasing it in over four years, as for other codes."
Both ASE and the Society of Cardiovascular Computed Tomography (SCCT) called the proposed cuts unsustainable, and pledged to organize their members to lobby Congress to prevent their implementation. SCCT said the use of American Medical Association Physician Practice Information Survey (PPIS) data in the calculations would be particularly damaging to imaging providers.
"The implementation of the PPIS dramatically cuts payment rates for cardiovascular and radiology services," SCCT said in a statement. "The bottom line is this data was not appropriately reviewed or validated. Cuts of this magnitude -- whether enacted this year or spread over four years -- cannot be absorbed."
CCTA rates published
On a positive note, CMS also announced the long-awaited base rates for the four new category I CPT codes for CCTA, the results of a two-year project by a multispecialty society team that included the SCCT, American College of Cardiology, American College of Radiology, American Society of Nuclear Cardiology, and North American Society of Cardiovascular Imaging.
Reimbursement rates were set largely at the level recommended by the Relative Value Update Committee, although there appear to be errors in practice expenses for codes 75572 and 75573, according to Washington, DC-based SCCT.
2010 CMS physician fee schedule provided by SCCT
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Cardiac PET increases
Cardiac PET was another bright spot for providers. Global payments increased approximately 17% due to increases in Medicare's Hospital Outpatient Prospective Payment System (HOPPS) that more than offset reductions in the professional fee component. For example, the 2010 global fee for CPT 78492 (heart image PET multiple) rises to $1,503.89 in 2010 from $1,258.47 in 2009. The global payment for CPT code 78459 (heart muscle imaging, PET) rises to $1,494.51 from $1,236.37 in the 2009 Medicare Physicians Fee Schedule, according to an analysis by the American Society of Nuclear Cardiology .
"The reason we're focusing on the cuts is that most of our doctors do MPI, which was hit hardest," a spokesperson for the Bethesda, MD-based society told AuntMinnie.com. "PET is not used as commonly as the myocardial perfusion imaging for our doctors."
Overall reimbursement
The SCCT noted that the new rule includes a 21.2% reduction in the Medicare conversion factor due to the sustainable growth rate (SGR) physician payment formula, set to begin January 1, 2010, unless Congress intervenes.
CMS decided to implement the American Medical Association's physician practice survey data, which dramatically cuts payment rate for cardiovascular and radiology services over the four-year implementation period, SCCT said.
As previously reported on AuntMinnie.com, beginning in 2010, for CT and MR scanner machines costing more than $1 million, CMS will increase its assumption of the amount of time the equipment is in use from 50% to 90% of the time a practice is open for business.
Relative value units (RVUs) and reimbursement will be cut. CMS will phase in this transition to new equipment utilization RVUs over a four-year period, SCCT said. The equipment utilization rate assumption for equipment priced less than $1 million will stay the same, but CMS said it will continue to explore whether an increase is warranted for other imaging services, according to SCCT.
CMS updated the malpractice RVUs with data from a new survey of specialty-level malpractice premiums, and the agency has proposed a new method for determining malpractice RVUs for technical component services. The proposed new malpractice RVUs would reduce cardiology payments by 1%. However, the impact is greater on services with high technical components such as imaging services.
Payments for consultations provided in both office and hospital settings are eliminated under the final rule. The RVUs assigned to these codes will be redistributed to office and hospital visits, and services now billed as consultations will be billed as hospital or office visits, SCCT said.
By Eric Barnes
By AuntMinnie.com staff writers
November 5, 2009
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How 2009 went right and wrong: VC's own worst enemies, October 28, 2009
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