Sec. 4003. Medicare payment incentive for the transition from traditional x-ray imaging to digital radiography and other Medicare imaging payment provision
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Section 1848(b) of the Social Security Act ( 42 U.S.C. 1395w–4(b) ) is amended by adding at the end the following new paragraph: In the case of an imaging service (including the imaging portion of a service) that is an X-ray taken using film and that is furnished during 2017 or a subsequent year, the payment amount for the technical component (including the technical component portion of a global service) of such service that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this section) for such year shall be reduced by 20 percent.
In the case of an imaging service (including the imaging portion of a service) that is an X-ray taken using computed radiography technology— in the case of such a service furnished during 2018, 2019, 2020, 2021, or 2022, the payment amount for the technical component (including the technical component portion of a global service) of such service that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this section) for such year shall be reduced by 7 percent; and in the case of such a service furnished during 2023 or a subsequent year, the payment amount for the technical component (including the technical component portion of a global service) of such service that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this section) for such year shall be reduced by 10 percent.
For purposes of this paragraph, the term computed radiography technology means cassette-based imaging which utilizes an imaging plate to create the image involved. In order to implement this paragraph, the Secretary shall adopt appropriate mechanisms which may include use of modifiers. . Section 1848(c)(2)(B)(v) of the Social Security Act ( 42 U.S.C. 1395w–4(c)(2)(B)(v) ) is amended by adding at the end the following new subclause: Effective for fee schedules established beginning with 2017, reduced expenditures attributable to subparagraph
(A)of subsection (b)(9) and effective for fee schedules established beginning with 2018, reduced expenditures attributable to subparagraph
(B)of such subsection. . Section 1848(b)(4) of the Social Security Act ( 42 U.S.C. 1395w–4(b)(4) ) is amended by adding at the end the following new subparagraph: For services furnished on or after January 1, 2017, the Secretary shall not apply a multiple procedure payment reduction to the professional component of imaging services unless the Secretary has published as part of a Medicare Physician Fee Schedule Proposed Rule the empirical analysis described in clause
(ii)with tables made available on the website of the Centers for Medicare & Medicaid Services. The empirical analysis described in this clause is an analysis of the Resource-Based Relative Value Scale Data Manager information or other information that is used to determine what, if any, efficiencies exist within the professional component of imaging services when two or more studies are furnished to the same individual on the same day. Such empirical analysis shall include— information detailing which physician work activities overlap and the reductions applicable to such overlap; a discussion of the clinical aspects that informed the assignment of the reduction percentages described in subclause (I); to the extent that such reductions are used for proposed payment reductions, an explanation of how the percentage reductions for pre-service, intra-service, and post-service work were determined and calculated; other data used to determine a reduction; and a demonstration that the Secretary has consulted with practicing radiologists to gain knowledge of how radiologists interpret studies of multiple body parts on the same individual on the same day. . Section 220(i) of the Protecting Access to Medicare Act of 2014 ( 42 U.S.C. 1395w–4 note) is repealed. Section 1833(t)(16) of the Social Security Act ( 42 U.S.C. 1395(t)(16) ) is amended by adding at the end the following new subparagraph: Notwithstanding the previous provisions of this subsection: In the case of an imaging service that is an X-ray taken using film and that is furnished during 2017 or a subsequent year, the payment amount for such service (including the X-ray component of a packaged service) that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this subsection) for such year shall be reduced by 20 percent. In the case of an imaging service that is an X-ray taken using computed radiography technology (as defined in section 1848(b)(9)(C))— in the case of such a service furnished during 2018, 2019, 2020, 2021, or 2022, the payment amount for such service (including the X-ray component of a packaged service) that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this subsection) for such year shall be reduced by 7 percent; and in the case of such a service furnished during 2023 or a subsequent year, the payment amount for such service (including the X-ray component of a packaged service) that would otherwise be determined under this section (without application of this paragraph and before application of any other adjustment under this subsection) for such year shall be reduced by 10 percent. The reductions made under this paragraph— shall not be considered an adjustment under paragraph (2)(E); and shall not be implemented in a budget neutral manner. In order to implement this subparagraph, the Secretary shall adopt appropriate mechanisms which may include use of modifiers. .
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- 42 USC 1395w–4(b)
- 42 USC 1395w–4(c)(2)(B)(v)
- 42 USC 1395w–4(b)(4)
- 42 USC 1395w–4
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Sec. 4003
Medicare payment incentive for the transition from traditional x-ray imaging to digital radiography and other Medicare imaging payment provision
Cite42 USC 1395w–4(b)
Cite42 USC 1395w–4(c)(2)(B)(v)
Cite42 USC 1395w–4(b)(4)
Cite42 USC 1395w–4
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