ACR shares ‘concern’ after CMS yanks coverage for certain exams, retroactive to 2019
The American College of Radiology is expressing “concern” after the Centers for Medicare & Medicaid Services removed coverage for certain exams, retroactive to 2019.
CMS’ noncoverage decision pertains to CPT codes 0554T-0558T, (biomechanical computed tomography, or BCT) used to describe services for measuring bone density. The agency issued transmittals earlier this year, asserting that these BCT codes should be removed from coverage, as they were “added in error.” And it wants the decision to date back to July of 2019, the college noted in a Thursday, May 4, news update.
ACR believes the move will sow confusion and is asking the agency to rescind its noncoverage determination.
“The ACR seeks guidance from CMS on how healthcare providers should handle claims using these codes going forward,” Chief Executive Officer William T. Thorwarth Jr., MD, wrote in an April 27 letter to a key agency leader. “We believe that claims paid using these codes should not be adjusted unless there is concern that these services were not properly furnished.”
Back in March, the agency directed contractors to adjust any claims for such services that were processed in error. But ACR emphasized that these codes have been contractor-priced under the Medicare Physician Fee Schedule since 2019. Plus, four Medicare Administrative Contractors have local coverage articles that include the CPT codes as covered services.
CMS’ transmittals have indicated that the services described in these codes “do not meet Medicare’s definition for bone mass measurements.” But the agency has failed to share any further facts to support these claims, the college said. Thorwarth and colleagues also believe CMS should have given providers a chance to comment on the change and plead their case against it.
“We think that a public notice period is warranted before any policy or article changes take effect on beneficiary access to care,” he wrote to Gift Tee, the director in the Division of Practitioner Services. “This allows time to educate and prepare healthcare providers about these policy changes, especially when code changes have the effect of limiting coverage for Medicare beneficiaries.”
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.