CMS 2020 payment rules draw cheers, disappointment across radiology

The Centers for Medicare & Medicaid Services recently published the final Medicare Physician Fee Schedule for 2020, drawing positive and negative reactions from various radiology groups.

The American College of Radiology, for example, said it was “disappointed” that CMS chose to finalize plans to implement a new coding structure for office/outpatient evaluation and management (E/M) services. 

Boosting reimbursement for E/M by about $5 billion, according to the ACR, would harm clinicians who do not often bill for such services. The price tag: around $450 million in one year, and about $5.6 billion over the coming 10 years, according to an ACR analysis.

“These changes will result in significant payment reductions to radiology services in 2021 unless Congress acts to suspend the budget neutrality requirement,” the ACR wrote of the changes going into effect on Jan. 1.

In October, the ACR reported radiologists sent nearly 4,500 emails and made more than 450 phone calls to members of Congress, urging lawmakers to amend the policy. In its summary of the finalized rule, the ACR vowed to work with Congress and use “every avenue available”  to limit the impact of the new policy on radiologists.

Nuclear medicine wins out

On the flip side, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) applauded the new policy—as well as the 2020 Hospital Outpatient Prospective Payment System final rule also issued Nov. 1—calling both “good news” for the field.

Myocardial PET reimbursement will remain at current levels instead of the 80% in cuts proposed by CMS early last month. And some SPECT and SPECT-CT studies will receive a 3.5% boost in reimbursement rather than the 157% decrease SNMMI feared possible. 

In September, multiple nuclear medicine and cardiology groups, including SNMMI, published a joint statement urging CMS to “reconsider” reimbursement cuts to PET services. That was followed by an Oct. 1 letter signed by 43 members of Congress asking CMS Administrator Seema Verma to delay cuts to myocardial PET scans.

“SNMMI thanks members for sending in comments, but most of all, for providing invoices, which helped convey to CMS the cost of making these services available to patients!” SNMMI said in a statement.