On January 1, 2006, Medicare and Medicaid implemented a 25 percent multiple procedure payment reduction on the technical component of certain diagnostic imaging procedures. Many private payers follow the government's lead and have done the same. But the American College of Radiology has noticed that some payers may be reducing payments for these global claims incorrectly, at the expense of providers.

Here's the background on this problem: The Centers for Medicare and Medicaid Services (CMS) reduced the reimbursement for contiguous body part imaging. For instance if a patient comes in for an MRI of his/her shoulder and then receives an additional imaging procedure on another part of his/her body during the same visit, a 25 percent reduction in reimbursement will be applied to the latter study. (CMS had planned a further reduction for contiguous studies starting this year but ACR successfully lobbied against it.)


Medicare reimburses hospitals and imaging centers for two categories of services: the professional component (PC) for the health care professional and the technical component (TC) for the facility and equipment.

The PC and TC are sometimes lumped together so that the 25 percent reduction in reimbursement is applied to both, even though the reduction is supposed to apply only to the technical component.

There are steps you can take to ensure that your private insurance payers are not making this error, according to the American College of Radiology.

When global bills (PC+TC) are submitted, the payer will sometimes arbitrarily reduce the entire global payment by 25 percent, thus inappropriately reducing the PC, ACR reports. This unintended and inappropriate arbitrage of the PC may also occur when radiologists outsource the professional component to independent facilities who then submit the global claim. Radiologists should advocate for separate itemized technical and professional billing, even when they are submitted on a single billing statement. Health plans also should insist on receiving separate claims for PC and TC.

Visit ACR for more details: http://www.ACR.org.

Keep in mind that reimbursement is based on a payment system of Current Procedural Terminology (CPT), which categorizes all medical services and assigns payment amounts for each. The system is organized into "families" of procedures. Several medical imaging services -- ultrasound, MR, CT -- may be part of the same family group.

For more details and a reference table, go to
http://www.acr.org/s_acr/doc.asp?CID=2540&DID=25621

To find out specifically which providers, CPT codes, and "families" of services are affected, go to
http://www.acr.org/s_acr/bin.asp?TrackID=&SID=1&DID=23852&CID=2362&VID=2&DOC=File.PDF

You may also contact the ACR's Economics Department at (800) 227-5463, ext.4043, if you continue to receive incorrect reimbursement or if you have additional questions.

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