Q&A: Why are our CT scan payments down?

Q: We have seen a decrease in payment for our CT scans this year. It is only affecting the scans that we report with modifier –CT (computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association [NEMA] Xr-29-2013 standard), so it isn’t all of them, but it is enough that our CFO has asked about it. It has affected our composite payment as well as those that are reported as the only service.

A: When CMS instituted the -CT modifier, it noted that beginning January 2016 there would be a 5% reduction in payment for procedures that included the modifier. Beginning January 2017, there would be a 15% reduction in payment. This reduction applies when an individual scan is the only service provided, and applies to the APC payment for composites APCs 8005 and 8006 (CT and CTA imaging families). This only applies for specific CPT codes, which are noted in the January 2017 update to the OPPS, Transmittal 3685, and in the Medicare Claims Processing Manual, Chapter 4, section 20.6.12.

Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.

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