Practitioners, medical groups and clinics, and independent diagnostic testing facilities (IDTFs)—or any eligible professional who has billed for the technical component (TC) of a CPT® advanced diagnostic code in the past six months, for that matter—can expect to receive the first of five letters from a Medicare contractor by Aug. 13. The letter is a reminder that they must be accredited by Jan. 1, 2012 to continue furnishing advanced diagnostic imaging services to Medicare beneficiaries.

Advanced diagnostic imaging includes magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET).

The Centers for Medicare & Medicaid Services (CMS) states in the letter: “Since we expect it can take up to nine months from the time you initiate the accreditation process to completion, we urge you to begin the accreditation process for advanced diagnostic imaging services as soon as possible.”

CMS approved three national accreditation organizations—the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission—to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures. The accreditation requirement applies only to the suppliers of the images themselves, and not to the physicians interpreting the images.

CMS July 9 Transmittal 727 replaces July 2 Transmittal 726 to change the implementation date and July 2010 reporting requirements so contractors have sufficient time to mail this first round of the notification letter to affected providers. Standard X-ray code 72200 Radiologic examination, sacroiliac joints; less than three views has been removed from the list of CPT® codes because it isn’t considered an advanced diagnostic imaging service.

Other diagnostic imaging types excluded from this accreditation requirement include ultrasound, fluoroscopy, and mammography.

The Patient Protection and Affordable Care Act (HR 3590) may affect your practice in more ways than you think. A provision in the health care reform bill changes disclosure requirements for in-office ancillary services.

Section 6003 of the reform bill amends the Stark law exception to the prohibition on physician self-referral for certain imaging services by adding one very long but extremely important sentence.

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The Centers for Medicare & Medicaid Services (CMS) recently revised National Coverage Determination (NCD) 220.6 – Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer.

Effective Feb. 26, CMS will cover NaF-18 positron emission tomography (PET) imaging when the Medicare beneficiary’s treating physician determines that it is needed to inform the initial antitumor treatment strategy or to guide subsequent antitumor treatment strategy after the completion of initial treatment, and when the beneficiary is enrolled in, and the NaF-18 PET provider is participating in, a clinical study.

Claims should contain ALL of the following information:

• PI Initial Treatment Strategy or PS Subsequent Treatment Strategy modifier
• PET or PET/CT CPT® code (78608, 78811-78816)
• ICD-9-CM cancer diagnosis code
• HCPCS Level II A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries
• Q0 modifier Investigational clinical service provided in a clinical research study that is in an approved clinical research study.

Institutional claims should continue to report ICD-9 diagnosis code V70.7 Examination of participant in clinical trial and condition code 30.

Note that, although this coverage decision is effective Feb. 26, it will not be fully implemented until a clinical study is ready to enroll providers and patients. Check the CMS coverage webpage for updates.

Read MLN Matters® No. MM6861, issued March 26, for complete details.

As with computed tomography (CT) and magnetic resonance imaging (MRI), there is a growing trend among non-radiologists to own or lease positron emission tomography (PET) equipment.

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Come Jan. 1, 2012, a provision in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires all suppliers of the technical component (TC) of advanced diagnostic imaging services suppliers to be accredited by an accreditation organization designated by the Secretary of Health and Human Services (HHS). To that end, the Centers for Medicare & Medicaid Services (CMS) has named three national accreditation organizations—The American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC) and The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO)—for the job.

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UnitedHealthcare recently announced an important policy change whereas all network physicians will be required to participate in the health plan’s Radiology Notification Program, effective Feb. 15, 2010.

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The 46 percent cut in single photon emission computed tomography (SPECT) reimbursement and 22 percent inrease in positron emission tomography (PET) reimbursement the Centers for Medicare & Medicaid Services (CMS) is proposing for 2010 has some speculating a significant rise in demand for cardiac PET in the coming years. Read more »

A literature review of comparison studies for medical imaging methods, published in the May/June issue of the Journal of Diagnostic Medical Sonography, puts ultrasound at the top of the list for accuracy and cost effectiveness.

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In a May 11 decision memo for screening computed tomography colonography (CTC) for colorectal cancer, the Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is inadequate to conclude that CTC is an appropriate colorectal cancer screening test and it remains noncovered.

Medical News Today has more on the story.

A National Coverage Determination (NCD) issued April 3 by the Centers for Medicare & Medicaid Services (CMS) expands coverage of positron emission tomography (PET) scans for the diagnosis and treatment of most solid tumor cancers in Medicare patients and removes the clinical study requirement in some cases.

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