CMS agrees to broaden MRI pay policy in response to radiology societies’ advocacy campaign
An advocacy campaign from five radiology groups has paid off, with the Centers for Medicare & Medicaid Services agreeing to broaden its payment policy for a crucial MRI exam.
The Society for Cardiovascular Magnetic Resonance teamed with RSNA, the American College of Radiology and others, writing letters and making phone calls to the federal agency. Their concerns stemmed from the use of cardiac MRI for velocity flow mapping, a technique that provides a display of the cardiovascular system at work.
CMS’s policy permits billing for the procedure a single time. However, imaging providers often must take multiple measurements, where medically necessary, for certain patients, including those with congenital heart defects.
The agency has now relented and agreed to allow radiologists and other providers to bill for CPT 75565 more than once in a visit, beginning on Oct. 1.
“We know that some of our most complex patients are those with congenital heart disease—and that the time it takes to evaluate them is extraordinary and a labor of love,” Carrie Kovar, a consultant to the Society for Cardiovascular Magnetic Resonance, wrote in a Sept. 28 news update. “After back and forth correspondence, and multiple phone calls, we are thrilled to announce that this campaign was successful,” she added later.
The American Roentgen Ray Society and Association of University Radiologists also joined in the advocacy effort. Beginning on Sunday, imaging providers can bill for 75565 up to four times per patient per day. The Society for Cardiovascular Magnetic Resonance noted that this is an add-on code. As such, it should be reported in conjunction with cardiac MRI for morphology and function (without contrast) material codes 75557, 75559, 75561 and 75563.
“It is important to document what valves/vessels/shunts/baffles you obtained flows on in the report, and state the numbers clearly,” the society said in a separate announcement, while also sharing an example.
CMS posted this revision in an update shared earlier this month. The American College of Radiology also alerted its members about the change in a Sept. 22 news post.
The Society for Cardiovascular Magnetic Resonance urged anyone with questions to contact their local Medicare Administrative Contractor.
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.