CMS Updates ICD-10 Codes for Radiology NCDs
Change Request 14194 details ICD-10 coding revisions for mammograms, PET for oncologic conditions and percutaneous image-guided breast biopsy.
Read moreThe U.S. House of Representatives Committee on Energy and Commerce Health Subcommittee sent 21 pieces of legislation intended to strengthen America’s health system to the full committee for consideration. As part of this markup, The American College of Radiology® (ACR®)-supported Facilitating Innovative Nuclear Diagnostics (FIND) Act of 2023 (H.R. 1199) is one of the forwarded bills. The FIND Act would remove radiopharmaceuticals from the packaging system in the Centers for Medicare and Medicaid Services (CMS) Hospital Outpatient Prospective Payment System and expand access to advanced diagnostic imaging.
Conditions continue to take a toll on Americans, including Alzheimer’s and Parkinson’s disease; advanced cardiac disease; and cancers of the breast, prostate and brain. However, Medicare’s current reimbursement structure limits patients’ access to innovative imaging tools that improve diagnosis of these deadly diseases. These tools provide previously unavailable information to support changes in patient management, which are demonstrated to lead to more appropriate treatment and a reduction in the utilization of unnecessary treatments that may be both expensive and debilitating.
CMS currently considers diagnostic radiopharmaceuticals as supplies through a packaged payment system, which creates a significant barrier to patient access to the newer, more precise generation of diagnostic nuclear imaging drugs. The FIND Act directs the Department of Health and Human Services to pay separately for all diagnostic radiopharmaceuticals with a cost threshold per day, meaning providers can better manage costs while also delivering more targeted and cost-efficient care.
ACR is encouraged to see the FIND Act advance out of the subcommittee and looks forward to working with Congress to ensure patients have access to advanced diagnostic imaging.
If you have questions or would like more information, contact Ashley Walton, ACR Director of Government Affairs.
CMS Updates ICD-10 Codes for Radiology NCDs
Change Request 14194 details ICD-10 coding revisions for mammograms, PET for oncologic conditions and percutaneous image-guided breast biopsy.
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