Dec. 3—Congress last week called for the reversal of drastic cuts in Medicare reimbursement for dual energy x-ray absorptiometry (DEXA), the imaging procedure accepted as the standard for diagnosing osteoporosis. The bill, H.R. 4206 “Medicare Fracture Prevention and Osteoporosis Testing Act of 2007," is sponsored by Rep. Shelley Berkley, D-Nev., and supported by 41 original co-sponsors.
The legislation seeks to improve access to, and increase utilization of bone mass measurement benefits under the Medicare Part B Program, she said.
Medicare reimbursement for DEXA has been cut to levels substantially below the cost to perform the procedure and as a result, many physicians, clinics and mobile services around the U.S. are discontinuing this health service — greatly reducing the public's access to the test and jeopardizing patients' quality of care, Berkley said.
According to Berkley, DEXA is used to identify those at risk for osteoporosis and for preventing and reducing fractures, which account for $18 million in national costs of direct care—expenditures which are projected to increase over the next two decades to $25.3 billion in 2025, according to Berkeley.
Specifically, the ACR said the measure would require the secretary of Health and Human Services to establish a national minimum payment amount for CPT code 77080 (relating to DEXA) and CPT code 77082 (relating to vertebral fracture assessment), and any successor to the codes as identified by the secretary. The amount is to be no less than 100 percent of the reimbursement rates in effect for each code on Dec. 31, 2006, and would be applied to services furnished on or after Jan. 1, 2008.
A recent study completed by The Lewin Group found that restoring DEXA reimbursement to the 2006 levels will save the Medicare program $1.14 billion over five years due to the reduced number of osteoporotic fractures, Berkley said.