August 09, 2018

MPFS Proposed Rule Generates Varied Rate Impacts

The American College of Radiology (ACR) has prepared impact tables showing the 2019 Medicare Physician Fee Schedule (MPFS) proposed rule would have varied effects on medical imaging payment rates if accepted without modification for diagnostic and interventional radiology, nuclear medicine and radiation oncology.

The tables cover specific changes in reimbursement rates between calendar years 2018 and 2019 for each Current Procedural Terminology® (CPT) code. The ACR analysis includes one spreadsheet for the 70,000 series CPT codes and another for the non-70,000 CPT codes that are billed by radiologists, interventional radiologists and/or radiation oncologists.

The 2019 MPFS proposed rule estimates no net overall change for diagnostic radiology and interventional radiology, a one percent overall decrease for nuclear medicine, and an overall two percent decrease for radiation oncology and radiation therapy centers. However, specific impacts vary widely for specific modalities and include either payment rate increases or decreases depending upon the procedure.

Many specific code impacts are related to the Centers for Medicare and Medicaid Services’ (CMS’) proposal to update practice expense direct inputs for supply and equipment pricing, based on market research conducted by contract with StrategyGen. The ACR is working with consultants to analyze the proposed changes and to determine if specific pricing updates are accurate.

For more information, please contact Kathryn Keysor, ACR senior director of economics and health policy.