Radiologists come out on top of 2017 MPFS ruling from CMS

CMS released its final ruling on the 2017 Medicare Physician Fee Schedule (MPFS) at the beginning of November, and radiologists will benefit from the changes.

Improvements to mammography payments and a temporary stay on slashing the technical component reimbursement outweigh losing several interventional radiology codes, according to Ezequiel Silva III, MD, Chair of the American College of Radiology’s Commission on Economics.

The rule’s benefits to breast screening come from increasing the relative value unit (RVU) for mammography. While the increase was small (0.04 RVUs), it shouldn’t be overlooked, according to Silva.

“CMS is acknowledging that mammography today is more work than when these codes were created 15 years ago,” said Silva, a vascular radiologist with South Texas Radiology Imaging Centers. “Radiologists are getting more engaged in patient interactions, communications with referring physicians, coordinating care—CMS is acknowledging that radiologists contribute to a wider range of care which is worthy of higher payments.”

“A nice little bonus for the specialty, if you will,” Silva added.

Imaging providers should note that starting in January 2017, codes for digital mammography, film screen mammography and computer-aided detection (CAD) mammography will be bundled into one set of three mammography codes.

“That basically captures every mammography code, whether it’s analog or digital,” said Silva. “We went from eight potential codes down to three to describe the same thing.”

However, CMS will keep the existing code numbers (G0202, G0204 and G0206) due to issues with claims processing.

“This is a big change for us, because I’ve been at lectures and panels telling audiences ‘Here come the new codes, get ready,’ but obviously those codes aren’t going to be put into place,” said Silva.

In addition, proposed cuts to the technical component reimbursement have been put on hold, with CMS saying they will revisit the evaluations in 2018. Silva and the ACR are pleased with the decision, avoiding a potential decrease of 50 percent in technical component reimbursement for 2017. Large medical centers could have most likely absorbed the reduction and maintained mammography programs, but smaller imaging providers would have had a tougher time.

CMS cited the potential for restricting access to beneficiaries as a primary motivator in delaying the cuts.

“If those practices aren’t able to offer those services, people are going to have to drive to cities or imaging centers—a problem because of how structured mammography is,” said Silva. “You get a screening, if there’s findings you gave to come back a do a diagnostic study, if there’s clinically significant images you have to come back for a biopsy or a surgical consultation.”

Not all changes favored radiologists, however.

Starting in January certain interventional radiology codes will be bundled, a change that will reduce reimbursement for some procedures. For example, cerebral arteriograms are currently reported with component codes, allowing doctors to receive payment for each vessel studied. Instead, procedures performed in 2017 will be reported wholesale, probably resulting in a lowered payment for half of the codes. The ACR has lobbied against these changes, arguing that all cerebral arteriograms are equally work intensive, but CMS disagreed.

Still, Silva praised the ACR’s activism on behalf of the specialty, saying they were pleased with the overall outcome in spite of individual disappointments.

For more information, read the ACR’s preliminary summary of the ruling.