AHA Coding Clinic® for HCPCS - 2005 Quarter 1; FOR your INFORMATION
Diagnostic mammography no longer paid under OPPS
A change in payment structure for diagnostic mammography, including diagnostic computer aided detection (CAD) services that are furnished by hospitals subject to OPPS became effective January 1, 2005. Provision for this payment modification can be found in Section 614 of the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003. On or after January 1, 2005 Medicare will pay for diagnostic mammography and CAD services based on the Medicare Physician Fee Schedule. Payment for the diagnostic mammography is no longer payable under the OPPS. This information was published by CMS in Transmittal 385. ...
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Article Overview
This article covers a Medicare policy update for hospital outpatient diagnostic mammography services and related computer aided detection billing. It is relevant to hospital coders, billing staff, and reimbursement professionals who follow OPPS and Medicare payment updates. The article notes the statutory basis and CMS transmittal context for the change and describes the general shift in payment method effective in 2005.
Why This Topic Matters
Understanding this update helps billing and coding staff recognize when Medicare payment for these services moved away from OPPS and into a different payment framework. It is important for maintaining accurate outpatient billing workflows and aligning claims processing with current Medicare policy references.
What You Will Learn
- The scope of a Medicare payment change for diagnostic mammography in hospital outpatient settings
- How related computer aided detection services are included in the policy update
- Which Medicare sources and federal references are associated with the change
- The effective date and general payment framework change discussed in the article
Who Should Read This
- Hospital coders
- Outpatient billing staff
- Reimbursement specialists
- Revenue cycle professionals
- Compliance staff
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