2016 Medicare Physician Fee Schedule Final Rule Radiology Summary

Most radiology practices will see a decrease of 0.5% to 1.0% in their overall Medicare reimbursement.  This decrease is similar for professional radiology practices and global imaging centers.  For the first time in several years, there is not a significant difference in the rate reduction for professional vs. global radiology billing. There are several CPT coding changes for 2016 that impact the CPT codes assigned to studies.  Fortunately, the monetary impact of these coding changes should be relatively minor for most practices. CMS has added two CPT codes to cover CT lung screening or low dose CT.  There is a code assigned to cover a CT lung screening (low dose CT).  There is also a code assigned to cover patient counseling for the appropriateness of CT lung screening. Providers who furnish CT studies who do not meet the updated dose standards as set by the National Electrical Manufacturers Association (NEMA) must utilize a ‘CT’ modifier when submitting CT studies to Medicare as of January 1^st of 2016.  If the equipment fails to meet the new dose standards, the Medicare reimbursement will be reduced by 5% in 2016 and 15% in 2017. The final rule provides the framework for referring physicians, who order advanced diagnostic imaging studies, to begin using appropriate use criteria by a clinical decision support mechanism.  A number of PQRS measures have been added to fill in gaps in the existing PQRS measure dataset.  For radiology, three diagnostic radiology PQRS measures and six interventional radiology PQRS measures have been added to assist radiologists in meeting the 9 measure requirement.