HCFA may cut payments for multiple echo exams

August 25, 1993

Medicare administrators are considering a cut in reimbursementfor multiple echocardiography modes performed in a single session.The proposal, which has encountered opposition from two cardiologyspecialty societies, could be a first step in reducing

Medicare administrators are considering a cut in reimbursementfor multiple echocardiography modes performed in a single session.The proposal, which has encountered opposition from two cardiologyspecialty societies, could be a first step in reducing Medicarereimbursement for many multiple diagnostic procedures.

The Health Care Financing Administration is looking at reducingpayment when a patient is scanned with two-dimensional echo (CPTcode 93307), spectral Doppler (93320) and color-flow Doppler (93325)in a single session. Under the proposal, HCFA would pay 100% ofthe physician fee schedule for the most expensive mode and only50% of the schedule for the other examinations.

If approved, the change would reduce technical component reimbursementby an average of $50 per session nationwide, according to a bulletinsent to members of the American Society of Echocardiography.

The proposed change applies HCFA criteria used to set reimbursementfor multiple surgical procedures to echocardiography. Those rulesstipulate that because of cost efficiencies in performing multiplesurgeries in a single setting, reimbursement should be 100% forthe initial procedure and 50% for subsequent ones.

Under the proposal, Medicare would pay the highest value CPTcode in full and 50% of the payment amount of the other CPT codesin the designated group. The rule would apply only to the specifiedCPT codes if they are furnished by a single physician or supplieron the same day for the same patient.

HCFA explained the echocardiography proposal by citing "obviousefficiencies in supplies, machine operating time, technician andphysician time, if these services are performed or interpretedon the same day." However, ASE officials asserted that HCFAhad already accounted for the concomitant performance of theseservices when the relative value units were established.

Representatives from ASE and the American College of Cardiologyconveyed their concerns directly to HCFA officials at a meetingthis month. HCFA officials are accepting comments on the proposaluntil Sept. 13.

HCFA hinted in the Federal Register that it could expand themultiple procedure rule beyond echocardiography to other diagnostictests as well.

"We are carefully reviewing all nonsurgical proceduresto determine other sets of codes that may be furnished with significantefficiencies when they are done on the same day by the same physicianor supplier for the same patient," the agency said. "Most,but not all, of the additional nonsurgical procedures we are evaluatingfor reduction are diagnostic tests."

Comments on the proposed rule can be sent to: Health Care FinancingAdministration, Department of Health and Human Services, Attention:BPD-770-P, Box 26688, Baltimore, MD 21207.