CMS Multiple Procedure Payment Reduction Not Happening Jan. 1

December 19, 2011

CMS won't apply 25 percent professional component Multiple Procedure Payment Reduction in 2012 for same practice-different physician services.

The Centers for Medicare and Medicaid Services will not apply in 2012 the professional component Multiple Procedure Payment Reduction (MPPR) for imaging services performed by separate physicians in the same group practice, the American College of Radiology announced Sunday. This decision will affect both office and hospital practices.

CMS informed the ACR that “operational limitations” will prevent them from applying the imaging professional component MPPR beginning Jan. 1. The ACR had lobbied heavily against the action.

Application of a 25 percent MPPR to the professional component of diagnostic imaging services performed by the same physician, to the same patient, during the same session remains the same. However, the ACR will continue its legislative efforts to block the entire professional component MPPR through enactment of H.R. 3269 in the second session of the 112th Congress. There are now 150 co-sponsors for this bill, according to the ACR.

“I am proud of the tremendous effort exerted by more than 7,000 ACR members to contact CMS and explain the flaws in its original ruling. I’m also very gratified and encouraged by the grassroots efforts of our members in gaining support from 150 members of Congress for H.R 3269” said John A. Patti, MD, FACR, chairman of the ACR board of chancellors. “While this bill did not appear in the final 2011 health care legislation, it is still alive and gaining more support for the next session.”

The ACR declared its opposition to the bill in early November. ACR officials then said the multiple procedure reduction will affect the most vulnerable of Medicare beneficiaries: people suffering from multiple trauma, stroke patients and those with widespread cancer. Such patients often require multiple scans to survive serious illness and injury, the interpretation of which can often require the expertise of several different radiologists, they added.

“No efficiencies in care support a funding cut when different physicians in a group practice interpret separate imaging scans for the same patient. There is no scientific support for this action,” Patti said at the time.