Health Information Management

Healthcare News: CMS increases multiple procedure payment reduction

JustCoding News: Outpatient, May 19, 2010

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On May 7, CMS issued Transmittal 694 in the One-Time Notification Manual announcing that the reduction for the technical component (TC) of certain diagnostic imaging procedures will increase from 25% to 50% effective July 1.

MedLearn Matters article MM6965 states the following:

  • The reduction applies to TC-only services and the TC portion of global services for the procedures with a multiple surgery value of ‘4’ in the Medicare fee schedule database.
  • The multiple procedure payment reduction does not apply to the professional component (PC) or to the PC portion of global services. The 11 families of imaging codes to which this policy applies are established according to modality (e.g., computed tomography, magnetic resonance imaging [MRI], and ultrasound) and body area.
  • The reduction applies only to more than one procedure performed in a single imaging session on contiguous body parts (i.e., within a family of codes, not across families). For example, the reduction would not apply to an MRI of the brain (CPT code 70552) in code family 5 (MRI/MRA head/brain/neck) performed on the same day and during the same session as an MRI of the neck and spine (CPT code 72142) in code family 6 (MRI/MRA spine).

It’s important to alert billing staff members of this change.



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