CT Colonography Billing Update
As a result of ACR advocacy efforts, physician offices can now bill for the professional component of CT colonography. The Centers for Medicare and Medicaid Services (CMS) published a notice instructing its carriers to accept claims submitted for CT colonography codes 0066T and 0067T, which are broken out by technical and professional components (ie, TC and –26 modifiers) in addition to global charges. The ACR educated CMS about a billing problem with CT colonography claims where certain Medicare carriers were only reimbursing for global charges and would not accept those claims that billed the professional or technical component alone (ie, TC and –26 modifiers). This problem has been corrected retroactively to January 1, 2005. Local Medicare carriers had until April 4, 2005, to update their systems. Please contact your local Medicare carrier for instructions on claims submission.
The ACR believes the CT colonography billing problem stemmed from a misinterpretation of the Medicare Physician Fee Schedule. CT colonography codes 0066T and 0067T are classified as category III codes and are not valued through the AMA Relative Value Update Committee process and reimbursed under individual payer policies. Because the category III codes are not valued at the national level, CMS does not specify the global, technical, and professional breakouts in the national physician fee schedule. Several Medicare carriers have mistaken this to mean that physician offices cannot bill out the professional and technical components separately. CT colonography is currently covered by a number of local carriers and may be one of the first category III codes to have been subject to this misinterpretation of the technical and professional breakouts.
Local Medicare carriers determine whether they will reimburse and at what level for the various category III codes. Therefore, this potential billing paradigm may not have fully surfaced and physician offices may not have run into category III code billing problems. Please alert the ACR if you submit a claim for a category III code and incur problems with technical and professional component billing.
To access a copy of the CMS 2005 Medicare Physician Fee Schedule quarterly update, please log on to the CMS Web site at http://www.cms.hhs.gov/manuals/pm_trans/R475CP.pdf.
If you are interested in obtaining a list of local carriers with CT colonography coverage policies, please go to the ACR Web site, select Reimbursement and Coding, then Local Coverage, then Find Local Medicare Policies.
For more information regarding category I, II, and III codes, please reference the September/October 2004 ACR Radiology Coding Source™ article, "Category I, II, and III Code Designation."
If you have questions, please contact the Economics and Health Policy Department at (800) 227-5463, ext 4043, or e-mail economics@acr.org.