CMS posts payment increases for MPI codes

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The Centers for Medicare & Medicaid Services (CMS) has released a technical correction to the 2010 Medicare Physician Fee Schedule, which results in payment increases for myocardial perfusion imaging (MPI) codes—both SPECT and planar—for private practices, and the corrections are retroactive to Jan. 1.

Due to the technical correction, physicians can expect to see reimbursement rates increase as a result of a higher practice expense relative value unit (RVU) used to calculate reimbursement rates for procedures and the increases vary per code, said the American Society of Nuclear Cardiology (ASNC).

The Society of Nuclear Medicine (SNM), the American Medical Association (AMA), the American College of Cardiology (ACC), along with ASNC met with CMS earlier this year to discuss errors made during the transition from 2009 codes for MPI to the new bundled codes for these services in 2010. The errors included incorrect practice expense values for CPT codes 78451-78454. 

“We’re still stuck with the devastating cuts to echo, as well as the cuts to support services for nurses and staff in private practices, so we’re not done,” Jack Lewin, MD, CEO of the ACC, said in an interview on May 7. 

The corrected payments for MPI posted by CMS are:
  • SPECT MPI, single (CPT code 78451-G), the corrected payment is $313.06, a 41 percent difference.
  • SPECT MPI, single (CPT code 78451-TC), the corrected payment is $246.70, a 59 percent difference.
  • SPECT MPI, multiple (CPT code78452-G), the corrected payment is $439.65, a 16 percent difference.
  • SPECT MPI, multiple (CPT code78452-TC), the corrected payment is $361.03, a 20 percent difference.
  • Planar MPI, single (CPT code78453-G), the corrected payment is $269.78, a 39 percent difference.
  • Planar MPI, single (CPT code78453-TC), the corrected payment is $221.09, a 52 percent difference.
  • Planar MPI, multiple (CPT code 78454-G), the corrected payment is $382.67, a 105 percent difference.
  • Planar MPI, multiple (CPT code78454-TC), the corrected payment is $318.47, a 161 percent difference.

Lewin announced that the correction notice also includes changes to malpractice RVUs for cardiac catheterization services. CMS agreed with ACC, SCAI, and the AMA that cardiac cath services should be assigned malpractice RVUs based on the higher surgical risk factor. However, the published RVUs and payment rates did not correctly reflect that policy change.

With this notice, according to Lewin, CMS has corrected its error. The payment changes—for example, an increase from $235 to $253 for 93510-26 (left heart catheterization, professional component)—reflect the higher risk associated with invasive procedures.