PROCEDURE PAYMENT REDUCTION (MPPR) POLICY TO THE PROFESSIONAL COMPONENT OF ADVANCED IMAGING SERVICE

In the Medicare Physician Fee Schedule Final Rule published last week, the Centers for Medicare & Medicaid Services (CMS) announced a Multiple Procedure Payment Reduction (MPPR) that applies a 25 percent reduction to the Professional Component of second and subsequent advanced imaging services furnished by the same physician (or same group practice) to the same patient, in the same session, on the same day. This is scheduled to take effect on Jan. 1, 2012.

Thanks in part to the extensive letter-writing and advocacy efforts of the ASNR, CMS was convinced to reduce the originally proposed 50 percent reduction to 25 percent. However, we remain bitterly disappointed in the 25 percent reduction, which is not supported by peer-reviewed documented evidence of efficiency.

Robert M. Barr, MD, Chair of the ASNR Clinical Practice Committee (CPC) and William D. Donovan, MD, MPH, FACR, Chair of the ASNR CPC Coding & Reimbursement Subcommittee, were two of the coauthors on a recent article in the Journal of the American College of Radiology (“Professional Component Payment Reductions for Diagnostic Imaging Examinations When More Than One Service Is Rendered by the Same Provider in the Same Session: An Analysis of Relevant Payment Policy“) that analyzed such efficiencies. The article was referenced extensively in the Final Rule. It provides compelling evidence that efficiencies are minimal and vary across modalities when multiple imaging services are performed by the same provider in the same session.

For a list of the advanced imaging services procedures that will be included, please click the following link: Advanced Imaging Service Subject to Expansion of MPPR. The ASNR CPC recommends that your practice conduct an analysis of its Medicare reimbursement in order to assess the impact that the expansion of the MPPR policy will have on future cash flow.

If you would like to read the Expanding the MPPR Policy section of the CMS Final Rule, that can be found on pages 140-171 of the following link: CMS Medicare Physician Fee Schedule Final Rule.

The ASNR will explore efforts to repeal the expansion of the MPPR to the professional component of advanced imaging services and will continue to vigorously defend the appropriate reimbursement of neuroradiologic procedures for our membership.

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