Patient Protection and Affordable Care Act – DXA Provision Text (Section 3111 of HR 3590)

SEC. 3111. PAYMENT FOR BONE DENSITY TESTS.

(a) Payment-

(1) IN GENERAL- Section 1848 of the Social Security Act (42 U.S.C. 1395w-4) is amended–

(A) in subsection (b)–

(i) in paragraph (4)(B), by inserting `, and for 2010 and 2011, dual-energy x-ray absorptiometry services (as described in paragraph (6))’ before the period at the end; and

(ii) by adding at the end the following new paragraph:

`(6) TREATMENT OF BONE MASS SCANS- For dual-energy x-ray absorptiometry services (identified in 2006 by HCPCS codes 76075 and 76077 (and any succeeding codes)) furnished during 2010 and 2011, instead of the payment amount that would otherwise be determined under this section for such years, the payment amount shall be equal to 70 percent of the product of–

`(A) the relative value for the service (as determined in subsection (c)(2)) for 2006;

`(B) the conversion factor (established under subsection (d)) for 2006; and

`(C) the geographic adjustment factor (established under subsection (e)(2)) for the service for the fee schedule area for 2010 and 2011, respectively.’; and

(B) in subsection (c)(2)(B)(iv)–

(i) in subclause (II), by striking `and’ at the end;

(ii) in subclause (III), by striking the period at the end and inserting `; and’; and

(iii) by adding at the end the following new subclause:

`(IV) subsection (b)(6) shall not be taken into account in applying clause (ii)(II) for 2010 or 2011.’.

(2) IMPLEMENTATION- Notwithstanding any other provision of law, the Secretary may implement the amendments made by paragraph (1) by program instruction or otherwise.

(b) Study and Report by the Institute of Medicine-

(1) IN GENERAL- The Secretary of Health and Human Services is authorized to enter into an agreement with the Institute of Medicine of the National Academies to conduct a study on the ramifications of Medicare payment reductions for dual-energy x-ray absorptiometry (as described in section 1848(b)(6) of the Social Security Act, as added by subsection (a)(1)) during 2007, 2008, and 2009 on beneficiary access to bone mass density tests.

(2) REPORT- An agreement entered into under paragraph (1) shall provide for the Institute of Medicine to submit to the Secretary and to Congress a report containing the results of the study conducted under such paragraph.

Last modified: December 27, 2012