November 9, 2015
The Protecting Access to Medicare Act (PAMA) established radiation dose requirements that will take effect on January 1, 2016. Medicare will reduce reimbursement to the technical component by 5% for CT scans acquired on technology that does not meet the new standards in 2016 and by 15% in 2017. CMS created the modifier “CT” to be reported with diagnostic CT CPT® codes (see list below) conducted on machines that do not meet the National Electrical Manufacturers Association (NEMA) CT guidelines.
Impact for Nuclear Medicine: This change will only affect providers using equipment that does not comply with the radiation dose requirements in PAMA and billing diagnostic CT services for the following codes: CPT® codes 70450 through 70498; 71250 through 71275; 72125 through 72133; 72191 through 72194; 73200 through 73206; 73700 through 73706; 74150 through 74178; 74261 through 74263; and 75571 through 75574 (and any succeeding codes).
Note: No nuclear medicine CPT codes are affected by this provision.
What should you do? First check with your manufacturer and obtain a letter for your billing files for each CT piece of equipment in your practice noting if the equipment meets or does not meet the standards. If all equipment meets the standards you don’t need to do anything. However, if one or more of your CT equipment does not meet the standard, you will need to work with your billing staff to identify from the list of CPT codes above any studies performed on those pieces of equipment so they can append the CT modifier this will result in a 5% reduction in payment rate for those services for CY 2016.