On July 12, the Centers for Medicare and Medicaid Services (CMS) issued its proposed plan for changes to the Medicare Physician Fee Schedule for 2019.1 Citing the need to reduce paperwork and improve patient care, the CMS detailed a number of changes to payments physicians receive from Medicare that could have a significant impact on…
ACR Investigates PAMA Impact on Lab Testing
Rapid, accurate and convenient point-of-care lab testing for patients is one of the promises of 21st century medicine. However, reimbursement cuts enacted through the Protecting Access to Medicare Act of 2014 (PAMA) threaten access to this testing, explains Colin Edgerton, MD, FACP, RhMSUS, partner in Articularis Healthcare and chair of the ACR’s Committee on Rheumatologic…
ACR Advocates Against Proposed UHC Policy Changes
UnitedHealthcare (UHC) recently proposed two policy changes that would have a negative impact on reimbursement for consultation services and evaluation and management (E/M) services when billed with modifier 25. The effective date for both of these proposed changes is Oct. 1, 2018. Consultation Services Under the proposed consultation codes policy, UHC would end reimbursement for…
Anthem Cancels Planned Modifier 25 Cuts
Anthem, a Blue Cross Blue Shield company that operates in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, Virginia and Wisconsin, has decided not to move forward with a policy that would have resulted in decreased reimbursement for evaluation and management (E/M) services when billed with modifier 25. As reported…
ACR Opposes UnitedHealthCare’s Move to End Consultation Reimbursement
Effective for claims with dates of service on or after Oct. 1, 2017, UnitedHealthCare (UHC) plans to no longer reimburse consultation services represented by CPT codes 99241–99245 and 99251–99255. In lieu of a consultation services procedure code, UHC says it will “reimburse the appropriate evaluation and management (E/M) procedure code which describes the office visit,…
ACR Opposes DXA Reimbursement Cuts
The Centers for Medicare and Medicaid Services (CMS) plans to significantly reduce reimbursement for dual-energy X-ray absorptiometry (DXA),—used to measure bone density, diagnose osteoporosis and help prevent fractures—performed as a hospital outpatient service in the 2017 Hospital Outpatient Prospective Payment System (HOPPS). If finalized, by 2023 it will cut payment for the DXA testing by 37%….