Medicare May Stop Paying Separately For Imaging
Contrast & Radiopharmaceuticals
Medicare may end its long-standing policy of paying separately for imaging contrast media &
radiopharmaceuticals. On July 16, 2007, the Centers for Medicare and Medicaid Services (CMS) issued
the 2008 proposed HOPPS rule on their website. The proposed rule provides a 3.3 percent increase
overall in Medicare payments to hospitals. The proposal would increase payment rates for CT from 5%
to 15% but would bundle the cost of contrast media into the payments for the same time. Similar
increases are planned for MRI.
Bundling under the proposed rule would not apply to the technical component of the Medicare
Physician Fee Schedule for non-hospital outpatient services and independent diagnostic testing
facilities. Thus, payment will continue to be made to IDTF and physician offices under the current
arrangements.
Key highlights of the proposed HOPPS rule include:
Threshold for Separately Payable Outpatient Drugs
CMS is proposing to continue the threshold for determining separately payable outpatient drugs despite
the fact that its statutory mandate has expired. They plan to adjust the threshold annually to reflect
inflationary changes in pricing. The amount proposed for 2008 is $60. (CMS will pay separately for drugs
that have a per day cost that exceeds $60.)
Payment for Contrast Agents in the HOPPS Setting
CMS proposes to package payment for all contrast agents into the associated separately payable
procedures even if the per day cost of the contrast exceeds the proposed $60 threshold. Their goal of
increased packaging notwithstanding, CMS notes that three quarters of all contrast agents would fall
under the proposed $60 threshold.
Payment for Radiopharmaceuticals in the HOPPS Setting
CMS has proposed packaging payment for diagnostic radiopharmaceuticals into the payment for the
nuclear medicine procedures. They propose to pay separately for those therapeutic
radiopharmaceuticals that have per day costs of more than $60.
Billing for Contrast Agents and Radiopharmaceuticals
CMS expects that hospitals will bill the contrast agent on the same claim as the other independent
service(s) for which the contrast agent was administered. This will ensure that CMS is appropriately
packaging the cost of the contrast agent into the payment for the significant independent procedure.
For
more
information
about
the
proposed
http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp
HOPPS
rule
visit: