CMS kick-starting new radiology prior-authorization policies on July 1, imaging advocates warn

With the calendar flipping over to July, new radiology prior-authorization policies are kickstarting this month, imaging advocates warned recently.

The changes apply to rad practices that provide interventional vein and vascular care in hospital outpatient facilities. Medicare Administrative Contractors started sending out letters about the shift last month, the Radiology Business Management Association noted in a Monday blog post.

With the switch, interventional radiologists must now obtain prior approval before billing CMS for eight imaging-guided procedures. Those include destruction of a vein in the arm or leg using chemicals, lasers or radiofrequency.

The Centers for Medicare and Medicaid Services first finalized these new prior-authorization policies in 2019 as part of its 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule.

“Although the rule was published last year, the appearance of the letters may lead to questions from your practice’s interventional radiologists, especially since prior authorization is a hot button issue,” RBMA advised its members June 29. “It is important to note that CMS has not changed medical necessity and documentation requirements for these procedures.”

CMS noted that it hopes this process will help to control unnecessary increases in the volume of these imaging-based services, while also protecting the Medicare Trust Fund from improper payments.

You can find the full list of procedures, with Current Procedural Terminology codes, here, and a sample letter from Medicare Administrative Contractors here. The American College of Radiology also warned its members of the changes last month.