September 27, 2018

CMS Issues Guidance on Billing IMRT Planning Services

The Centers for Medicare & Medicaid Services (CMS) recently issued an MLN Matters article reminding how hospitals that bill for outpatient Intensity-Modulated Radiation Therapy (IMRT) planning services should bill Medicare correctly and avoid overpayments.

The MLN Matters article was published in response to an August 2018 Office of the Inspector General report, which makes two recommendations to CMS to avoid future overpayments.

One was to implement an edit to prevent improper payments for IMRT planning services that are billed before (e.g., up to 14 days before) the procedure code for the bundled payment for IMRT planning is billed.

The other advises CMS to work with the Medicare contractors to educate hospitals on properly billing Medicare for IMRT planning services.

Because of the coding guidance alerts issued since January 2017, the American College of Radiology recommends that hospitals check their billing process to ensure that they are billing Medicare correctly for IMRT planning services.