November 11, 2016

CMS Sets Aside Bundled Mammography With CAD CPT Codes for HCPCS Codes

Citing shortcomings in the Medicare claims processing system, the Centers for Medicare and Medicaid Services (CMS) has elected not to use the new Current Procedural Terminology (CPT®) 2017 codes that bundle computer-aided detection (CAD) with mammography services.

CMS has revised the Healthcare Common Procedure Coding System (HCPCS) Level II “G” code descriptors to be the same as the CPT code descriptors, as noted in the Medicare Physician Fee Schedule Final Rule. For 2017, codes G0202, G0204 and G0206 will describe mammography with CAD when performed for Medicare beneficiaries. Radiology practices are advised to check with their other third-party payers to see if they will be using the CPT or HCPCS Level II “G” codes in 2017.

Note that the professional component work relative value unit (RVU) increases, as recommended by the American College of Radiology, were finalized by CMS. However, CMS decided not to update the practice expense RVUs to the Relative Value Scale Update Committee recommended values, which would have yielded a 50 percent cut. They note that they intend to re-visit in 2018.

Refer to Advocacy in Action eNews for the ACR summaries and analyses of the 2017 Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System Final Rules.