Has Medicaid Reimbursement Killed CR?

The changes to Medicare reimbursement rates for film and CR x-rays have a big effect on the decision to go for CR or DR equipment. But there is still a lot of confusion over those rate changes, even now, months after the first of them have gone into effect.

The Consolidated Appropriations Act reduces payments for those providers using Analog (Film) and CR Technologies to incentivize the adoption of new (DR) technologies. Reimbursement for film has already been reduced, and starting in 2018 and increasing slowly until 2023, reimbursement for CR will also drop. However, it is not exactly true that the reimbursement for CR will be cut by 7%, as you will usually see quoted. The Medicare Physician Fee Schedule (MPFS) is generally split into two components, each separately billable to the local Medicare Contractor for reimbursement. The Professional Component, which is for Physician work interpreting a Diagnostic test and comprises 30% of the fee, is not being touched! The Technical Component, which is for all non-Physician work (Administrative, Personnel & Capital (Equipment & Facility) costs, comprises roughly 70% of an imaging fee. This is being cut by 7% for all CR exams beginning in 2018 (20% for Film).

So, what does this fee reduction roughly look like in real dollars and cents numbers? Using 70% as the technical component,

Exam Exam Code Total Fee Approximate Fee Reduction for CR (in 2018) Approximate Fee Reduction for Film
2 View Chest 71020 $58.35 $2.86 $8.17
2 View Shoulder 73030 $51.57 $2.53 $7.22
2 View T-Spine 72070 $60.39 $2.96 $8.45
3 View Wrist 73110 $48.84 $2.39 $6.84
2 View Hip 73510 $54.96 $2.69 $7.69
4 View Knee 73564 $59.04 $2.89 $8.26

As you can see, there is still a large advantage in reimbursement rates changing to CR from film, and of course an even greater advantage in going full DR.

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