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Payment Reduction for Computed Radiography

Published on 

Tuesday, November 28, 2017

 | RAC Information 
 | FAQ 

Q:

Will Medicare payments be reduced for 2018 for X-rays taken using computed radiography imaging?  If so, why?


A:

Yes, payments for imaging services taken using computed radiography imaging will be reduced for CY 2018 and subsequent years. The Consolidated Appropriations Act, 2016, which was enacted on December 18, 2015, contains provisions to incentivize the transition from traditional X-ray imaging to digital radiography by reducing payment for older imaging technology. 

The reduction for computed radiography (CR) will be phased in over several years. The Act requires that payments for CR services furnished during CY 2018, 2019, 2020, 2021, or 2022, be reduced by 7%, and if such services are furnished during CY 2023 or a subsequent year, by 10%. Computed radiography technology is defined as cassette-based imaging which utilizes an imaging plate to create the image involved.

CMS created a new modifier – modifier “FY” (X-ray taken using computed radiography technology/cassette-based imaging) to be reported on claims to identify those HCPCS codes that describe X-rays taken using CR technology. The payment reduction (7% for 2018) will be taken when this modifier is reported with the applicable HCPCS code(s) to describe imaging services that are taken using CR technology.

Already implemented beginning in 2017 as a requirement of the Act, payment for X-rays taken using film is reduced by 20 percent. Providers are required to report modifier “FX” (X-ray taken using film) with the appropriate HCPCS codes to identify x-rays taken using film.  The 20% payment reduction is taken when this modifier is reported with the applicable HCPCS code(s) for film x-rays. This 20% reduction began in January 1, 2017 and continues for subsequent years.

Due to increased packaging of payment for ancillary services over the past few years, payment for some x-ray services is packaged into the payment for the primary service. When payment for an X-ray service taken using film or computed radiography imaging is packaged into the payment for another item or service under the OPPS, no separate payment for the X-ray service is made. Therefore, there will be no payment reduction for packaged x-ray services.

Article Author: Debbie Rubio, BS MT (ASCP)
Debbie Rubio, BS MT (ASCP), was the Manager of Regulatory Affairs and Compliance at Medical Management Plus, Inc. Debbie has over twenty-seven years of experience in healthcare including nine years as the Clinical Compliance Coordinator at a large multi-facility health system. In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.