The American College of Radiology issued a detailed breakdown of the Medicare Physician Fee Schedule Friday, offering insight into the “complex” formula for how much the specialty stands to lose.

ACR noted the importance of budget neutrality, which requires corresponding cuts to counter any pay increases. The Centers for Medicare & Medicaid Services is proposing to implement add-on code G2211, billed primarily for office and outpatient evaluation and management encounters, next year, which impacts radiologist pay.

Medical societies have lobbied to delay implementation of this change, which was originally slated for 2019. But it’s now set to take effect in 2024, accounting for “roughly 90%” of the budget neutrality impact.

“There is often a great deal of confusion around the impact tables and conversion factor changes, as CMS calculations are often complex and difficult to decipher,” the college said in a July 28 news update. “As stated above, the rule is not final until published as such, and impact numbers are subject to change. In addition, each individual practice will experience unique impacts depending on case mix and services offered,” it added later.

ACR said it worked with Richard Heller, MD—a member of its economics commission and an associate CMO for Rad Partners—to crunch the numbers. Along with G2211, Congress added a 2.5% bump to the fee schedule conversion factor in 2023, which is being halved in 2024 to account for a 1.25% pay reduction. Changes to RVUs also add to the mix, ACR said, accounting for the other 10% of the budget neutrality impact.

Bottom line: DR stands to sustain a 3% decrease, 4% for interventional radiologists, 3% for nuclear medicine specialists, and 2% drop for radiation oncologists/therapy centers. But this does not include the impact of losing the 1.25% conversion factor bump from 2023, with the college forecasting final pay reduction figures to be about 1%-2% higher.

“The ACR estimates that without further congressional action, the reduction to diagnostic radiology will be approximately 4%, although as stated previously, the cut to any specific practice will vary based on types and volumes of codes billed,” the news updated noted.

You can read the professional association’s full 21-page breakdown of the 2024 MPFS for free here. ACR also issued a detailed breakdown of the 2024 Hospital Outpatient Prospective Payment System proposed rule, which can be found here.