Medicare to pay 5% less for CT scans acquired on non-compliant technology

In January 2016, Medicare will begin reimbursing 5 percent less for CT scans that are acquired on technology that does not meet Standard XR-29-2013, the latest specifications for CT dose optimization published by the National Electrical Manufacturers Association’s Medical Imaging & Technology Alliance (MITA).

The policy was a provision of the $21 billion bill signed by President Obama last week that prevents a 24 percent SGR-mandated physician pay cut, according to a report from Health Data Management. Standard XR-29-2013, also known as MITA Smart Dose, was published in April of 2013.

For many years, leaders in radiology have questioned the practice of providing the same level of reimbursement for scans acquired on both state-of-the-art and aging technology. In initiating reduced reimbursement for CT scanners that do not meet the 2013 standard, Medicare proposes paying less for scans acquired on CT scanners equipped with anything less than state-of-the-art software.

Referred to in Section 218 of H.R.4302 as quality incentives, the penalties will apply to the technical component and the technical component of the global fee billed under the Medicare Physician Fee Schedule and the hospital outpatient prospective payment system. Penalties rise quickly to 15 percent in 2017 and thereafter, adding a sense of urgency to the upgrade cycle for all CT technology owners.

The standard includes four key features that enable optimization and management of radiation dose delivery and preserve the quality of the imaging studies:

  • DICOM Radiation Dose Structured Report, enabling the recording of dose information in a standardized electronic format.
  • CT Dose Check, which automates dose notifications and dose alerts that warn operators and physicians when dose exceeds established thresholds.
  • Automatic exposure controls (AEC) that automatically adjust the amount of radiation to keep dose within prescribed limits for desired image quality.
  • Pediatric and adult reference protocols, a set of pre-loaded parameters on a CT system that can be selected by the operator to complete a particular clinical task, such as capturing an image of the abdomen.

Mita Smart Dose is the fourth dose-related standard to be released by MITA since 2010, reflecting the industry’s response and the FDA’s efforts in addressing reported incidents of patient over-radiation.