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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)

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Physician payments

Public comments are due Aug. 24 on CMS' proposed physician fee schedule for calendar year 2011, 1posted online June 25. The proposal moves to implement various provisions from the Patient Protection and Affordable Care Act, including one that sets the assumed equipment utilization rate, used to calculate payments for advanced imaging, to 75%. This will establish a lower per-scan payment than the historical 50% use rate, but a higher payment than would have resulted from CMS' pre-Affordable Care Act plan for a 90% use rate (2"The Gray Sheet" Nov. 2, 2009). The proposal was released the same day that the president signed a bill into law to hold off an across-the-board 21.3% physician payment cut through Nov. 30, replacing it with a 2.2% pay increase

Imaging Lobbyists Support Baucus Medicare Provisions

The imaging industry says it is satisfied with how Medicare imaging payments are addressed in Sen. Max Baucus' health care reform bill

Imaging Use Assumption Increase Crops Up In Physician Fee Proposal

Whether or not Congress fulfills promises to enact medical imaging physician payment cuts next year, CMS said July 1 that it plans to do just that through its own administrative means

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