HCFA moves to pay for nonionics

A proposal to provide differentiated Medicare reimbursement fornonionic radiographic contrast media was embedded in the same187-page rule containing the relative-value scale regulations(see previous story). Nonionic agents are currently reimbursedat the same rate as less expensive ionic contrast agents.

HCFA proposes to accept the ACR criteria for use of the agentsas a policy for payment. Such criteria include history of previousadverse reaction to contrast, a history of asthma or allergy,significant cardiac dysfunction, severe debilitation, and sicklecell disease. The agency is investigating costs for the mediato determine an appropriate payment amount.

While HCFA's movement toward payment for nonionic contrastis encouraging, such payment should not be part of a physicianreimbursement fee schedule, said Dr. James Moorefield, AmericanCollege of Radiology chairman.

"This is a drug issue, not a physician services issue,"he said. "Payment should not wax and wane as conversion factorswax and wane. And if it's calculated as part of the initial conversionfactor, because the payment scheme must be budget neutral, ineffect you are not laying out any money to pay for it at all,"Moorefield said.