Changes in Medicare reimbursement for echocardiographic procedures

Area of Science:

• Cardiology
• Medical Reimbursement

Background:

• Medicare classifies echocardiographic procedures as "radiologic," leading to a potential 40% reimbursement limitation in some states.
• The Omnibus Budget Reconciliation Act of 1987 introduced a new radiology fee structure impacting echocardiographic services without specialist input.

Purpose of the Study:

• To address the complexities and potential financial implications of Medicare's classification of echocardiographic services.
• To advocate for appropriate coding practices to ensure accurate reimbursement for cardiac ultrasound studies.

Main Methods:

• Analysis of Medicare's coding and reimbursement policies for ultrasound services.
• Review of the impact of the Omnibus Budget Reconciliation Act of 1987 on cardiology practices.

Main Results:

• Medicare's "radiologic" definition for ultrasound services can result in a 40% reimbursement reduction.
• Negotiated radiology fee structures may negatively affect echocardiographic service reimbursement.

Conclusions:

• Physicians performing and interpreting cardiac ultrasound studies should utilize medicine codes (90,000 series) instead of radiology codes (70,000 series).
• Accurate coding is crucial for appropriate Medicare reimbursement of echocardiographic procedures.