2006 proposed fee schedule - American Society of Clinical Oncology

supplies. Using billing data, we identified a number of
273
contiguous body areas for which imaging is performed during
the same session. Next, because our proposed discounting
policies are based on the expectation that facilities will
achieve savings by not having to expend more than once, many
of the resources associated with performance of a second,
and any subsequent procedures, we organized the families by
imaging modality.
We propose extending the multiple procedure payment
reduction to TC only services and the TC portion of global
services for the procedures in Table 29, below. At this
time, we propose applying the reduction only to procedures
involving contiguous body parts within a family of codes,
not across families. For example, the reduction would not
apply to an MRI of the brain (CPT 70552) in code family 5,
when performed in the same session as an MRI of the neck and
spine (CPT 72142) in code family 6. When multiple
procedures within the same family are performed in the same
session, we propose making full payment for the TC of the
highest priced procedure and payment at 50 percent of the TC
for each additional procedure. The following is an example
of the current and proposed payments:
74183 72196
Total
Current
Payment
Total
Proposed
Payment
Payment
Calculation
PC $117.00 $90.00 $207.00 $207.00 no reduction
TC $978.00 $530.00 $1,507.00 $1,243 $978 + (.5 x $530)