DecisionHealth, DecisionHealth - 2011 Issue 11 (November)

Benchmark of the Week: Estimated loss for test reads by specialty, 2012

This chart looks at how much money specialties will lose on interpreting diagnostic CT, MRI and ultrasound tests that will be hit by the Multiple Procedure Payment Reduction (MPPR) in 2012. These 10 specialties were chosen because they had the highest annual payments from Medicare for billing modifier 26 (professional component) claims for the 119 imaging codes to be eligible for MPPR cuts to the professional component (PC). NOTE: To come up with estimated losses, the annual amount paid to that specialty in 2010 – the latest year of CMS data available – is used as a baseline. For each specialty, we estimated the percent of their test reads for the 119 codes that would represent multiple scans of the same patient read in the same session. These percentages were based on interviews with practice managers from the specialties, and can vary.

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