August 26, 2020

Impact Tables Show Code Level Effects of E/M Updates

The American College of Radiology® (ACR®) has prepared impact tables showing the 2021 Medicare Physician Fee Schedule (MPFS) proposed rule would have primarily negative 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 2020 and 2021 for each Current Procedural Terminology® (CPT) code. The ACR analysis includes a spreadsheet for the 70,000 series CPT codes and another spreadsheet for the non-70,000 CPT codes that are billed by radiologists, interventional radiologists and/or radiation oncologists.

The Centers for Medicare and Medicaid Services (CMS) estimates an overall impact of the MPFS proposed changes to radiology to be an 11%decrease, while interventional radiology would see an aggregate decrease of 9%, nuclear medicine an 8% decrease, and radiation oncology and radiation therapy centers a 6% decrease if the provisions within the proposed rule are finalized. However, specific impacts vary for specific modalities and include either payment rate increases or decreases depending upon the procedure.

Most specific code impacts are related to the -10.61% budget neutrality adjustment necessary due to changes in coding and valuation of evaluation and management services.