American College of Radiology reports continued progress in fight over payment for key CT service
The American College of Radiology is reporting continued progress in its fight over payment for a key CT service.
This controversy relates to computed tomography cerebral perfusion analysis, used to assess for signs and symptoms of a stroke. Medicare Administrative Contractors have “consistently denied coverage” for such exams in cases where patients present with stroke symptoms, but images later show no negative or related abnormalities.
ACR declared “partial victory” in May when Palmetto GBA—1 of 7 MACs, representing Alabama, Georgia, North Carolina, Tennessee, South Carolina, Virginia and West Virginia—agreed to cover the exam. Now the college is sharing further progress, with two more MACs agreeing to provide coverage.
“Ongoing engagement by the American College of Radiology’s Contractor Advisory Committee network with Medicare Administrative Contractors is resulting in expanded access to CT Perfusion Analysis (CPT code 0042T),” ACR said in an Oct. 2 news update. “Physicians will now be reimbursed for CT Perfusion studies that include signs and symptoms for stroke patients even without positive findings.”
Those coming aboard include WPS Government Health Administrators (impacting Iowa, Kansas, Missouri, Nebraska, Indiana and Michigan) and National Government Services (impacting Connecticut, Illinois, New Hampshire, New York, Maine, Massachusetts, Minnesota, Rhode Island, Vermont and Wisconsin). ACR also shared links to updated billing and coding documents from both WPS (with the changes effective Aug. 29) and NGS (Sept. 15).
Noridian Healthcare Solutions also is considering updating its policies, ACR noted.
“Efforts continue to petition other MACs to make changes to their policies to reflect the inclusion of these diagnosis codes,” the college said in its news update. “Providers should monitor all local coverage determination policies and updates using the Medicare Coverage Database; these policies ensure radiologists are appropriately reimbursed for medically reasonable and necessary services provided to Medicare patients,” it added later.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.