American Society of Echocardiography – Organization of ...



May 23, 2014To: ASE MembersFrom:Advocacy Committee/Coding and ReimbursementUnited Healthcare Adopts Multiple Procedure Payment Reduction: Technical Component (TC) of Diagnostic Cardiovascular Procedures; Applicable to Echocardiography and Non-Invasive Vascular Ultrasound Procedures Performed in the Physician OfficeUnited Healthcare Commercial and Community Plan will revise the current Radiology Multiple Imaging Reduction Policy to additionally apply the Multiple Procedure Payment Reduction (MPPR) for diagnostic cardiovascular services. This affects procedure payments for patients who are enrolled in these plans. United Healthcare noted they are implementing this policy to better align with the Centers for Medicare and Medicaid Services (CMS). These changes will occur in the third quarter of 2014. Rationale: In January 2013, CMS expanded its MPPR policy to cover Diagnostic Cardiovascular services assigned a multiple procedure indicator (MPI) of “6”. Consistent with the CMS National Physician Fee Schedule, United Healthcare will apply the discount to the second and subsequent procedures for the technical component (TC) only and to the TC of global services assigned an MPI of “6”. This policy does not affect the professional component payment.Reference: : This policy will apply when multiple cardiovascular services assigned a MPI of 6 are furnished to the same patient on the same day by the same physician or multiple physicians in the same group practice reporting under the same federal tax identification number (TIN). Echocardiography and non-invasive vascular procedures are currently assigned a MPI of “6” as are other diagnostic tests such as stress tests, ECGs, nuclear medicine, etc. (see list of procedures). Example, Office PaymentsFull payment is made for the TC service with the highest Relative Value Units (RVU). Payment is made at 75% for subsequent TC services furnished by the same physician (or by multiple physicians in the same group practice) to the same patient on the same day. Since United Healthcare payment rates are contractually set and are not publically available, the following is an example of how payments will be calculated:Echo and SPECT performed in the office: Technical Component (TC) or Global Payment:CPT 93306 (TTE) and CPT 78452 (SPECT) = SPECT full payment + Echo (.75 x 93306 payment)Cardiovascular Services CPT Codes Subject to MPPR of Technical Component75600Contrast exam thoracic aorta75605Contrast exam thoracic aorta75625Contrast exam abdominl aorta75630X-ray aorta leg arteries75658Artery x-rays arm75705Artery x-rays spine75710Artery x-rays arm/leg75716Artery x-rays arms/legs75726Artery x-rays abdomen75731Artery x-rays adrenal gland75733Artery x-rays adrenals75736Artery x-rays pelvis75741Artery x-rays lung75743Artery x-rays lungs75746Artery x-rays lung75756Artery x-rays chest75791Av dialysis shunt imaging75809Nonvascular shunt x-ray75820Vein x-ray arm/leg75822Vein x-ray arms/legs75825Vein x-ray trunk75827Vein x-ray chest75831Vein x-ray kidney75833Vein x-ray kidneys75840Vein x-ray adrenal gland75842Vein x-ray adrenal glands75860Vein x-ray neck75870Vein x-ray skull75872Vein x-ray skull epidural75880Vein x-ray eye socket75885Vein x-ray liver w/hemodynam75887Vein x-ray liver w/o hemodyn75889Vein x-ray liver w/hemodynam75891Vein x-ray liver75893Venous sampling by catheter78428Cardiac shunt imaging78445Vascular flow imaging78451Ht muscle image spect sing78452Ht muscle image spect mult78453Ht muscle image planar sing78454Ht musc image planar mult78456Acute venous thrombus image78457Venous thrombosis imaging78458Ven thrombosis images bilat78466Heart infarct image78468Heart infarct image (ef)78469Heart infarct image (3d)78472Gated heart planar single78473Gated heart multiple78481Heart first pass single78483Heart first pass multiple78494Heart image spect93000Electrocardiogram complete93005Electrocardiogram tracing93015Cardiovascular stress test93017Cardiovascular stress test93024Cardiac drug stress test93025Microvolt t-wave assess93040Rhythm ecg with report93041Rhythm ecg tracing93224Ecg monit/reprt up to 48 hrs93225Ecg monit/reprt up to 48 hrs93226Ecg monit/reprt up to 48 hrs93229Remote 30 day ecg tech supp93268Ecg record/review93270Remote 30 day ecg rev/report93271Ecg/monitoring and analysis93278Ecg/signal-averaged93279Pm device progr eval sngl93280Pm device progr eval dual93281Pm device progr eval multi93282Icd device progr eval 1 sngl93283Icd device progr eval dual93284Icd device progr eval mult93285Ilr device eval progr93286Peri-px pacemaker device evl93287Peri-px icd device eval&prgr93288Pm device eval in person93289Icd device interrogate93290Icm device eval93291Ilr device interrogate93292Wcd device interrogate93303Echo transthoracic93304Echo transthoracic93306Tte w/doppler complete93307Tte w/o doppler complete93308Tte f-up or lmtd93312Echo transesophageal93314Echo transesophageal93318Echo transesophageal intraop93350Stress tte only93351Stress tte complete93701Bioimpedance cv analysis93724Analyze pacemaker system93784Ambulatory bp monitoring93786Ambulatory bp recording93788Ambulatory bp analysis93880Extracranial bilat study93882Extracranial uni/ltd study93886Intracranial complete study93888Intracranial limited study93890Tcd vasoreactivity study93892Tcd emboli detect w/o inj93893Tcd emboli detect w/inj93922Upr/l xtremity art 2 levels93923Upr/lxtr art stdy 3+ lvls93924Lwr xtr vasc stdy bilat93925Lower extremity study93926Lower extremity study93930Upper extremity study93931Upper extremity study93965Extremity study93970Extremity study93971Extremity study93975Vascular study93976Vascular study93978Vascular study93979Vascular study93980Penile vascular study93981Penile vascular study93990Doppler flow testingSource: 2014 MPFS, File RVU14C, Codes with Multiple Procedure Indicator designated as “6” ................
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