Low Dose CT for Lung Cancer Screening      
 
Yesterday CMS announced that Medicare would begin to cover low dose CT for lung cancer screening. CMS will now cover the exam for individuals between 55-77 years of age with a 30 pack-year smoking history and who currently smoke or have quit within the past 15 years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes). Patients will also have to receive a written order from a physician or qualified non-physician practitioner that meets certain requirements. Apparently no decision announced yet by CMS on the amount of reimbursement for the procedure.

Medi-Cal had released a notice to also cover last month and just posted the following notice for clarification which adopted similar criteria. You will note that Medi-Cal will process claims on a By Report basis. We are in contact with DHCS to get information on how they will price payment. Now that Medicare will reimburse they will be bound to not pay more than 80% of the Medicare allowable.   

Updated Requirements for Lung Cancer Screening With Low-Dose CT

February 02, 2015

 

Contrary to what an article stated in the December 2014 Medi-Cal Update, claims for HCPCS code S8032 (low-dose CT lung screening) will be reimbursed "By Report" only, and do not require an invoice.

 

In addition, the required report must document one or more of the following criteria to justify the need for the use of low-dose computed tomography (CT):

  • Current or former smokers, 55 to 74 years of age
  • A smoking history of at least 30 pack-years (a pack-year is the calculated equivalent of smoking 20 cigarettes every day for one year)
  • No history of lung cancer

 


Workers Compensation Fee Schedule for Radiology       
 
The Workers Compensation Program converted to a Medicare RVS based reimbursement system using multiple conversion factors including a unique one for radiology. As we have described before the radiology conversion factor began in 2014 and is reduced over a three year period. If you have tried to find a list of the actual fee schedule for radiology services on the Division of Workers Compensation website you know that there is no actual fee schedule posted for any medical services.

We have been in contact with another medical specialty organization who had an outside consultant do the math and create a list of all the CPT codes and the applicable allowable under the Work Comp unit values and conversion factor. We are providing a link to a PDF that has the fee schedule for radiology procedure codes.   

 

Click here for Physicians Fee Schedule Table RADIOLOGY ONLY. 

 

ACR Fellowship Application        
 

We encourage members who are eligible to apply for ACR fellowship to submit an application for consideration. The process is now conducted through a portal on the ACR website that allows the applicant to submit the application, cv, and letters of support electronically through that portal. The CRS is notified once the application is complete and then we review the application for endorsement. For information on the categories for the award of Fellowship and how to submit electronically go to www.acr.org, click membership icon, and the choose Awards and Honors. The fellowship application has to be complete, considered by the state chapter, and endorsed by the chapter to ACR prior to June 30, 2015. We encourage you to begin that process and be completed prior to June 1st so that we have time for our review. You can contact JP Baird at the ACR for any fellowship questions. He is at jpbaird@acr.org.