CMS spares radiation payments, delays imaging cuts
This article was originally published in The Gray Sheet
Executive Summary
The utilization rate assumption used to calculate Medicare payments for scans with advanced diagnostic imaging equipment selling for more than $1 million will increase from 50% to 90% under CMS' 2010 final physician fee schedule, issued Oct. 30. The change, which will significantly reduce per-scan physician payments, will be phased in over a period of four years rather than being imposed all at once in January 2010, as originally proposed 1("The Gray Sheet" July 6, 2009). Radiation oncology equipment was spared in the ruling, with CMS saying it will not apply the change to expensive therapeutic equipment, as it would have in the July 1 proposed fee schedule. But Medicare imaging physician payment policy may ultimately be determined by Congress. Pending health care reform bills in the House and Senate would mandate increased imaging utilization rate assumptions, but not by as high as 90% (2"The Gray Sheet" Sept. 21, 2009)