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Effective January 1, 2011, sets the utilization rate assumption for advanced diagnostic imaging services (ADIS) at 75% for the practice expense portion of Medicare physician payment. Excludes non-advanced services like x-rays and EKGs. Increases the discount to the technical component of payment for imaging performed on a contiguous body part during the same session from 25% to 50%, effective July 1, 2010.
CMS implemented both of these provisions in the CY11 Physician Fee Schedule Final Rule.
SEC. 3135. MODIFICATION OF EQUIPMENT UTILIZATION FACTOR FOR ADVANCED IMAGING SERVICES. (a) ADJUSTMENT IN PRACTICE EXPENSE TO REFLECT HIGHER PRESUMED UTILIZATION.—Section 1848 of the Social Security Act (42 U.S.C. 1395w–4) is amended— (1) in subsection (b)(4)— ø(A) in subparagraph (B), by striking ‘‘subparagraph (A)’’ and inserting ‘‘this paragraph’’; and øAmendment made by section 1107(1)(A) of HCERA in effect reverses this amendment¿¿ (B) by adding at the end the following new subparagraph: ‘‘(C) ADJUSTMENT IN IMAGING UTILIZATION RATE.—øReplaced by section 1107(1)(B) of HCERA¿ With respect to fee schedules established for 2011 and subsequent years, in the methodology for determining practice expense relative value units for expensive diagnostic imaging equipment under the final rule published by the Secretary in the Federal Register on November 25, 2009 (42 CFR 410 et al.), the Secretary shall use a 75 percent assumption instead of the utilization rates otherwise established in such final rule.’’; and (2) in subsection (c)(2)(B)(v), by adding at the end the following new subclauses: øReflects amendment made by section 1107(2) of HCERA that struck subclauses (III), (IV), and (V) inserted by this paragraph and inserting a single new subclause¿ ‘‘(III) CHANGE IN UTILIZATION RATE FOR CERTAIN IMAGING SERVICES.—Effective for fee schedules established beginning with 2011, reduced expenditures attributable to the change in the utilization rate applicable to 2011, as described in subsection (b)(4)(C).’’. (b) ADJUSTMENT IN TECHNICAL COMPONENT ‘‘DISCOUNT’’ ON SINGLE-SESSION IMAGING TO CONSECUTIVE BODY PARTS.—Section 1848 of the Social Security Act (42 U.S.C. 1395w–4), as amended by subsection (a), is amended—(1) in subsection (b)(4), by adding at the end the following new subparagraph: ‘‘(D) ADJUSTMENT IN TECHNICAL COMPONENT DISCOUNT ON SINGLE-SESSION IMAGING INVOLVING CONSECUTIVE BODY PARTS.—For services furnished on or after July 1, 2010, the Secretary shall increase the reduction in payments attributable to the multiple procedure payment reduction applicable to the technical component for imaging under the final rule published by the Secretary in the Federal Register on November 21, 2005 (part 405 of title 42, Code of Federal Regulations) from 25 percent to 50 percent.’’; and (2) in subsection (c)(2)(B)(v), by adding at the end the following new subclause: ‘‘(VI) ADDITIONAL REDUCED PAYMENT FOR MUL- TIPLE IMAGING PROCEDURES.—Effective for fee schedules established beginning with 2010 (but not applied for services furnished prior to July 1, 2010), reduced expenditures attributable to the increase in the multiple procedure payment reduction from 25 to 50 percent (as described in subsection (b)(4)(D)).’’. (c) ANALYSIS BY THE CHIEF ACTUARY OF THE CENTERS FOR MEDICARE & MEDICAID SERVICES.—Not later than January 1, 2013, the Chief Actuary of the Centers for Medicare & Medicaid Services shall make publicly available an analysis of whether, for the period of 2010 through 2019, the cumulative expenditure reductions under title XVIII of the Social Security Act that are attributable to the adjustments under the amendments made by this section are projected to exceed $3,000,000,000.
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