March 10, 2017

ACR Urges CMS to Halt Mammography Payment Cuts

Led by Dr. Ezequiel Silva, chair of the ACR Commission on Economics, the ACR met with Centers for Medicare and Medicaid Services (CMS) staff this week to discuss a potential 50 percent payment reduction to the technical component of mammography services and to ensure continued patient access to these lifesaving services.

In 2017, there are three new CPT codes (77065, 77066 and 77067) for mammography studies. In November 2016, the ACR notified members about changes to the coding structure and potentially to future payment rates for mammography services. However, CMS opted not to use the new 2017 Current Procedural Terminology (CPT®) codes that bundle computer-aided detection (CAD) with mammography services. Instead, in the final rule, CMS stated they will use the old G codes with the new CPT descriptor. For 2017, codes G0202, G0204 and G0206 describe mammography with CAD when performed for Medicare beneficiaries. Radiology practices were advised to check with their third-party payers to determine if they will use the CPT or HCPCS Level II “G” codes in 2017.

With regard to reimbursement, CMS granted a slight increase in 2017 for the physician work relative value unit (RVU) as recommended by the ACR, but it decided against updating the technical component RVUs based on direct inputs recommended by Relative Value Scale Update Committee (RUC). An affirmative decision by CMS on the updates would have yielded a 50 percent cut in 2017 payment rates. CMS noted in the final rule that it intends to revisit this issue in 2018, however.

In this week’s meeting with CMS, Silva stressed the importance of mammography as an essential part of women’s health care and the potentially adverse impact of impeding access to the services because of such deep rate cuts. He urged CMS to maintain the current reimbursement rates indefinitely.

CMS staff members indicated this issue is on their radar, and they welcomed additional information from the ACR to support them as they develop the Medicare Physician Fee Schedule proposed rule for 2018.

As we assess the potential impact of implementing the new rates, the ACR is interested in hearing from you on what a 50 percent cut to the technical component of mammography services would mean for your practice and patients. Please contact Katie Keysor, Director, Economics and Health Policy, at kkeysor@acr.org to share any analysis that your practice has done on this issue.