CT Dose Recording Clean-Up Bill Goes to Governor

Yesterday the Senate passed AB 510 (Lowenthal) which is a clean-up bill to Senator Padilla's CT legislation that took effect on July 1, 2012. AB 510 is now on its way to the Governor and since it contains an urgency clause will be effective upon his signature, which will likely occur in the next 10 days. AB 510 makes a number of technical changes to the law that are supported by the CRS. We will provide a summary of those changes once the law is signed and will likely include an updated FAQ document from the Radiologic Health Branch that will reflect those changes.

As we reported in our last email the language regarding inclusion of the dose in the radiology report has not been materially altered. The section now actually refers to the interpretative report and the dose must be dictated into the report or the protocol page included in that report and accessible. We will provide the details in our next communication after AB 510 is signed into law.

SB 1538 (Simitian) that requires inclusion of a notice to women who are determined to have dense breast tissue when undergoing screening mammography has passed the Assembly Health Committee on a vote of 14-0. It now moves to the Assembly Appropriations Committee where it will be heard in August. SB 1538 was amended to provide a slight modification to the actual notice language, we believe in an effort to appease the Governor who had vetoed a similar bill from last year. The author has publicly indicated that he is amenable to a variety of notice variations, i.e. sample ACR lay letter to women with dense breast tissue, so long as the Governor finds the version acceptable. Here is the new language for the notice with the added verbiage in italics;

"Because your mammogram demonstrates that you have dense breast tissue (a relatively common condition), which could hide small abnormalities, you might benefit from supplementary screening tests, depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician's office and you should contact your physician if you have any questions or concerns about this notice."

We have printed below the announcement from Medi-Cal regarding changes in reimbursement for certain imaging procedures for patients provided on the same day. The changes took effect on July 1, 2012 and had been under discussion for some time.

We should also note that the recently enacted budget trailer bills also call for DHCS to implement as of July 1, 2012 the reduction in Medi-Cal reimbursement for radiology services to pay no more than 80% of the Medicare allowable for the same service. As you will recall that changes was supposed to take effect on 10/1/10 but was never approved by CMS via a State Plan Amendment (SPA). The CRS is also prepared to seek injunctive relief when the change is announced. We will keep you advised.

Reimbursement Reduction for Similar Services During Same Session

Effective for dates of service on or after July 1, 2012, Medi-Cal will reduce its reimbursement for the professional component of Computed Tomography, Computed Tomographic Angiography, Magnetic Resonance Imaging and Magnetic Resonance Angiography procedures when more than one service of the same type of imaging is furnished by the same physician to the same patient, in the same session on the same day.

Reimbursement for the professional component will be 100 percent for the service with the highest reimbursement price, and the reimbursement for the professional component of similar services provided during the same session will be reduced to 75 percent.

Reimbursement for the technical component will be 100 percent for the service with the highest reimbursement price, and the reimbursement for the technical component of similar services provided during the same session will be reduced to 50 percent.

Reimbursement reduction will occur for similar services only, for example, a CT scan followed by a CT scan. There will be no reduction when different types of imaging services are provided, such as a CT scan followed by an MRI scan.

Reimbursement for multiple services during different sessions on the same day remains at 100 percent for each service.

When two or more similar types of imaging services are furnished by the same provider to the same patient on the same day, providers must document the date, times and CPT-4 codes of the services and note on the claim whether the services were performed in the "same session" or "different session" or attach reports of the imaging studies that show the date, times and CPT-4 codes