March 13, 2018

CMS Issues Billing Modifier FY

On March 2, 2018, the Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 10515 containing changes to the Outpatient Prospective Payment System (OPPS) in April 2018.

In the CR, CMS notifies providers and suppliers that it has established modifier “FY” (X-ray taken using computed radiography technology/cassette-based imaging) to appropriately report computed radiography services.

Effective January 1, 2018, hospital outpatient facilities are required to use this modifier with the applicable HCPCS code(s) to describe an imaging service that is an X-ray taken using computed radiography technology.

The Consolidated Appropriations Act of 2016 outlined a gradual series of reimbursement reductions to both analog/film radiography and computed radiography. The Act contains provisions for a phased-in reduction in payment in the case of an imaging service that is an X-ray taken using computed radiography technology. Payment for such a service (including the X-ray component of a packaged service) furnished during CY 2018, 2019, 2020, 2021 or 2022, will be reduced by 7 percent, and if such a service is furnished during CY 2023 or a subsequent year, by 10 percent. For purposes of this reduction, computed radiography technology is defined as cassette-based imaging which utilizes an imaging plate to create the image involved.

CMS refers to an imaging service that is an X-ray taken using computed radiography technology. Where the imaging service is comprised of multiple images that include both X-rays taken using computed radiography technology and images taken using digital radiography, CMS does not believe the payment reduction would apply to that service. Instead, the payment adjustment applies to an imaging service that is an X-ray taken using computed radiography technology where the X-ray taken using computed radiography technology is not combined with digital radiography in the same imaging service.

See MLN Matters article MM 10515 for further details.