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Another Round of Potential Physician Reimbursement Reductions

July 6, 2011 | Comments Off on Another Round of Potential Physician Reimbursement Reductions
Posted by Beth Christian

On July 1, 2011, the Centers for Medicare and Medicaid Services (“CMS”) published proposed changes to the Medicare physician fee schedule for calendar year 2012.  CMS announced that absent a change in law, Medicare payments to physicians would be reduced by 29.5% effective January 1, 2012 as a result of the application of the sustainable growth rate formula reduction.  We have discussed the sustainable growth rate conundrum in several prior blog posts (  CMS is hoping for a legislative solution to the problem (temporary as it may be), as evidenced by the CMS statement that the “President’s budget submission for fiscal year (FY) 2012 would extend current payment rates through Dec. 31, 2013.”

CMS has also proposed additional modifications to the methodology for payments for certain radiology services in case where a patient receives more than one radiology service per day.  Under the proposal, CMS is proposing to extend its multiple procedure payment reduction (MPPR) policy to the professional component (PC) of advanced imaging services – specifically, computed tomography (CT) scans, magnetic resonance imaging (MRI), and ultrasound.  Under this proposal, the procedures with the highest PC payment would be paid in full.  The PC payment would be reduced by 50 percent for subsequent procedures furnished to the same patient, on the same day, in the same session.

CMS will accept comments on the proposed rule until August 30, 2011.


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