Get Ready for Radiology Billing Changes in 2020

Get Ready for Radiology Billing Changes in 2020

The Centers for Medicare & Medicaid Services (CMS) recently published the final Medicare Physician Fee Schedule for 2020, drawing positive and negative reactions from various radiology groups.

The American College of Radiology, said it was “disappointed” that CMS chose to finalize plans to implement a upgraded coding structure for office/outpatient evaluation and management (E/M) services.

Boosting reimbursement for E/M by about $5 billion would harm clinicians who do not often bill for such services, according to the ACR. The price tag: around $450 million in one year, and about $5.6 billion over the coming 10 years, according to an ACR analysis.

The biggest CPT changes for radiology in 2020 fall under GI imaging and nuclear medicine modalities with several revisions for clarity and consistency as well as some additions

The CY 2020 Medicare Physician Fee Schedule Final Rule was placed on display at the Federal Register on November 1, 2019. This final rule revise payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2020.

Many “radiologic exam” codes were revised, including 74022, 74210, 74220, 74230, 74240, 74246, 74250, 74270 and 74280. Codes 74241, 74245, 74247, 74249 and 74260 will be deleted. Updates also were made to myocardial imaging. Codes 78459, 78491 and 78492 were revised. New codes include:

CPT Code 78429: Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion(s), and/or ejection fraction(s), when performed) single study; with concurrently acquired computed tomography transmission scan

Code 78430: Myocardial imaging, PET, perfusion study (including ventricular wall motion(s), and/or ejection fraction(s), when performed); single study, at rest or stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan

CPT Code 78431: multiple studies at rest and stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan

CPT Code 78432: Myocardial imaging, positron emission tomography, combined perfusion with metabolic evaluation study (including ventricular wall motion(s), and/or ejection fraction(s), when performed), dual radiotracer (eg, myocardial viability)

CPT Code 78433: with concurrently acquired computed tomography transmission scan

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