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CMS-1403-FC of between 21 and 44 percent. Given the expected interaction between the MPPR policy and the further imaging payment reductions mandated by section 5102(b) of the DRA, along with the information we received from the ACR on the MPPR as it applies to common combinations of imaging services, we decided it was prudent to maintain the MPPR at its current 25 percent level while we continue to examine the appropriate payment levels. Therefore, we have maintained the MPPR at the 25 percent level. In establishing the MPPR, we elected to use a single reduction percentage for all code pairs. We adopted a percentage reduction that is considerably lower than the range supported by our prior analysis, and slightly higher than the lowest percentage supported by ACR’s analysis. We do not believe it is necessary to conduct another analysis for the additional codes because we adopted a conservative reduction percentage and are continuing use of a single reduction percentage for all code pairs. We believe the payment reduction policy, described above, represents an appropriate reduction for the typical delivery of multiple imaging services furnished in the same session. Furthermore, in establishing the MPPR, we limited it to codes in the same family, that is, contiguous areas of the body that are commonly furnished on the same patient, 136
CMS-1403-FC in the same session, on the same day. We believe that the eight CPT codes that were newly created for 2007 or 2008, and proposed for inclusion in the MPPR beginning in CY 2009 (CPT codes 70554, 75557, 75559, 75561, 75563, 76776, 77058, and 77059), would have been included on the MPPR list when it was finalized in CY 2006, had they existed at the time. These CPT codes are similar to CPT codes that were selected for the list in CY 2006 and can be classified into the 11 contiguous body area families already in existence. For example, the procedure described by CPT code 76776 (Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation) is similar to the procedure described by CPT code 76705 (Ultrasound, abdominal, real time with image documentation; limited (for example, single organ, quadrant, follow-up), which has been subject to the MPPR since the creation of the policy in CY 2006. Similarly, we believe we should add CPT codes 70336 and 76870, which were in existence in CY 2006, to the list because they also share characteristics with other procedures subject to the MPPR. In response to the commenter expressing concern that we were adding the breast MRI CPT codes 77058 and 77059 in particular, we are not certain of the reason for his or her concern because none was stated. However, we continue to believe it is appropriate to add these CPT codes because their addition is consistent with our policy for other 137
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<strong>CMS</strong>-1403-FC<br />
in the same session, on the same day. We believe that the<br />
eight CPT codes that were newly created for 2007 or 2008,<br />
and proposed for inclusion in the MPPR beginning in CY 2009<br />
(CPT codes 70554, 75557, 75559, 75561, 75563, 76776, 77058,<br />
and 77059), would have <strong>been</strong> included on the MPPR list when<br />
it was finalized in CY 2006, had they existed at the time.<br />
These CPT codes are similar to CPT codes that were selected<br />
for the list in CY 2006 and can be classified into the 11<br />
contiguous body area families already in existence. For<br />
example, the procedure described by CPT code 76776<br />
(Ultrasound, transplanted kidney, real time and duplex<br />
Doppler with image <strong>document</strong>ation) is similar to the<br />
procedure described by CPT code 76705 (Ultrasound,<br />
abdominal, real time with image <strong>document</strong>ation; limited (for<br />
example, single organ, quadrant, follow-up), which <strong>has</strong> <strong>been</strong><br />
subject to the MPPR since the creation of the policy in CY<br />
2006. Similarly, we believe we should add CPT codes 70336<br />
and 76870, which were in existence in CY 2006, to the list<br />
because they also share characteristics with other<br />
procedures subject to the MPPR.<br />
In response to the commenter expressing concern that we<br />
were adding the breast MRI CPT codes 77058 and 77059 in<br />
particular, we are not certain of the reason for his or her<br />
concern because none was stated. However, we continue to<br />
believe it is appropriate to add these CPT codes because<br />
their addition is consistent with our policy for other<br />
137