CMS proposes cuts for 'add-on' imaging studies

The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed paying a reduced rate for additional imaging procedures that are performed after an initial imaging study is done.

In an announcement yesterday, CMS outlined a number of proposed changes to its Outpatient Prospective Payment System (OPPS), including an overall 3.2% increase in payments for outpatient services.

The new proposals include a recommendation to pay a reduced rate for some medical imaging procedures when they are performed with other imaging procedures in the same session with the patient. CMS said the proposal reflects the lower costs that are incurred when the additional procedures are performed.

CMS has identified 11 "families" of imaging procedures, based on the type of modality used and the contiguous body area, where the policy would apply. When two or more procedures in the same family are performed, the first procedure would be paid in full and a discount of 50% would be applied to subsequent procedures.

Medicare said the proposed change was recommended to Congress by the Medicare Payment Advisory Commission (MedPAC).

In other changes that relate to medical imaging, CMS said it would be proposing changes to the way Medicare pays for Part B drugs, biologicals, and radiopharmaceuticals. Currently, Medicare pays 83% of the average wholesale price, which CMS claims is significantly higher than what is charged on the market.

Instead, CMS is proposing that Medicare pay 106% of the manufacturer's average sales price, a structure that mirrors the pricing methodology already used for drugs administered in the physician's office. Payment rates under the new methodology would be updated quarterly.

The agency said the new proposals will be published in the July 25th issue of the Federal Register.

By staff writers
July 18, 2005

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