CMS Reimbursement Rates for Outpatient CMR Set to Increase in 2018

On November 1, 2017, the U.S. Centers for Medicare and Medicaid Services (CMS) issued the Final 2018 Rule on the Hospital Outpatient Prospective Payment System (OPPS).  This rule sets forth Medicare reimbursement rates for the technical component (equipment, supplies, staffing, etc.) of services provided in the hospital outpatient setting.  In this annual rulemaking, CMS combines individual medical services (CPT codes) into Ambulatory Payment Classification (APC) groups. All services included within an individual APC group are reimbursed at the same rate.  By law, services included within an APC group are required to be similar clinically and in resource usage. SCMR is pleased to report modest increases in the 2018 technical component payment for all four CMR codes (CPT codes 75557, 75559, 75561 and 75563) over 2017 levels.  In July CMS had proposed a move of the CMR codes into different APC groups, which would have resulted in severe cuts in reimbursement for the two CMR codes with contrast: CPT 75561 and 75563.  The SCMR assembled a team of clinicians and government relations consultants and reached out to other imaging stakeholders and the American College of Cardiology to garner support for keeping the four CMR CPT codes in the same APC groups as in 2017. In August, SCMR leaders met with CMS representatives in Baltimore to present arguments against the proposed cuts, and to explain why the CMR codes should remain in the same APC groups as in 2017.  We presented the best case possible for appropriate placement of CMR services within the APC structure, both in our meeting with CMS and in our written comments on the proposed rule. In the Final OPPs Payment Rule released by CMS yesterday, the CMR codes were not moved as originally proposed by CMS, and as a result all four CMR codes will see modest increases in reimbursement in 2018. While we are pleased with the outcome this year, constant effort and vigilance is required to maintain adequate reimbursement for CMR. CMS relies on a restricted set of cost data based on a small subset of Medicare claims. There is an urgent need for all facilities to accurately capture the cost of each and every component of providing a CMR service. Charge masters should be updated to appropriately reflect these costs.  Consult the SCMR website or contact the SCMR Headquarters for more information on steps you can take to help insure that reimbursement rates are commensurate with the value of CMR.