Radiology and Radiation Oncology Regulatory Changes for 2015 Medicare and Medicaid programs have received significant modifications under the Affordable Care Act. The act has also impacted the revenue pattern for various practices. The Centers for Medicaid and Medicare Services (CMS) announced the 2015 Physician Fee Schedule and it proposed payment changes for medical practices that include radiology. This fee schedule also includes transparency in the development of payment rates, new updates for ambulance fee schedule regulations and implementation of separate payment procedures for chronic care management. Impact on Radiology Billing Services Radiologists and radiation oncologists will see reimbursement changes in 2015. These new regulations will have an impact on radiology billing services. The Medicare’s feasibility to reimburse radiologists under Physician Fee Schedule Proposed Rule (PFSP) is being considered by the CMS currently. This consideration is for reimbursing radiologists when additional interpretation of an existing image is requested. As far as the practice expenses are concerned, CMS has suggested that radiation treatment vaults should be classified as indirect practice costs rather than direct charges. Numerous coding changes have also been introduced for radiology practices. In the upcoming 2015 PFSP, CMS has asked for deletion of mammography G-codes that are currently the only authorized method for billing radiology services using tomosynthesis. The CMS has suggested that all mammography services be billed under established CPT codes. CMS has also challenged the current mammography CPT codes saying that they are mis-valued. A review has been requested for ensuring that some important factors are considered when setting the payment reimbursements such as, appropriate relative value units or accurate reflected direct practice expenses.
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