CMS Proposes New Fee Schedules for 2017
Reimbursement for Hospital Outpatient DXA is Slashed; Office-Based DXA Reimbursement Remains Low
On July 14, 2016, the Centers for Medicare and Medicaid Services (CMS) published the proposed rule for the Hospital Outpatient Prospective Payment System (HOPPS) for 2017. CMS has proposed to cut the reimbursement rate for Axial DXA, CPT 77080 in the hospital setting from the current national average of $100.69 to $63.33. This reimbursement cut will further limit access to DXA testing that has resulted from the 75% reimbursement cut for DXA in the office setting that has taken place over the past decade. CMS also proposes to decrease DXA reimbursement in the office setting from the current $41.56 to $40.78.
Additionally, the proposed HOPPS rule addresses reimbursement rates for certain services, including DXA, that are provided in physician practices acquired by hospitals (referred to in the rule as Off-Campus Physician Based Departments or PBD). This proposal would affect DXA services billed in these PBDs. If the hospital acquired the practice prior to November 2, 2015, fees for DXA can continue to be billed at the higher HOPPS rate of $63. However, any hospital that acquired a PBD after November 2, 2015, or any existing PBD that bills for a new line of services after November 2, 2015, will be reimbursed for DXA at the lower Physician Fee Schedule Rate of $40.78.
The ISCD is working with the National Osteoporosis Foundation (NOF), the National Bone Health Alliance (NBHA), and other organizations to address the latest cuts to DXA testing. We will also meet with CMS representatives to discuss the overall crisis in DXA testing that is the result of continued slashing of reimbursement rates for DXA over the past 10 years.
We will be reaching out to you for help as we draft comments objecting to the proposed provisions that would further limit access to DXA testing. Please contact Donna Fiorentino at email@example.com if you have questions or are interested in becoming more involved in our advocacy efforts.
ISCD Continues to Work on Legislation to Increase DXA Reimbursement.
HR 2461, Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2015 was introduced in the House in May to restore funding for DXA testing.
Representatives Marsha Blackburn, R-TN, Michael Burgess, R-TX, John Larson, D-CT and Linda Sanchez, D-CA are the lead sponsors on the bill and we have been working over the past few months to generate additional co-sponsors. (As of January 2016, we are up to 29 co-sponsors in the US House. Click here to check if your Member of Congress is signed on to the bill.)
In the Senate, we have been working to identify a Republican Lead Sponsor to join Senator Chuck Schumer and introduce the companion legislation. This is where you come in. Your grassroots outreach to members in the House and Senate are crucial to our advocacy efforts on DXA. We need Members of Congress to understand patients are at risk because of CMS’ policy on DXA.
Patients are another important element of our advocacy efforts and would be incredibly helpful in demonstrating the immediate need for legislative action. We would appreciate your assistance in identifying patients who would be willing to share their stories. We are developing additional materials to educate patients, including a petition and take away flyer that can be printed in the office and used in the waiting room.
While we have good data on how the DXA cuts have impacted testing and provider rates, it is the patient impact that is most difficult to quantify. In the past, our DXA story document was a powerful tool in convincing Members of Congress to join the fight for DXA. Provider and patient stories by state effectively illustrated the need for action. Good examples of how the DXA cuts have affected patients convey a powerful personal message that is hard to ignore.
Your actions over the next few months will be essential to our success. Please contact Donna Fiorentino at firstname.lastname@example.org with any feedback from your communication with Members of the House and Senate. We would be happy to assist in crafting your patient or provider stories and as always thank you for your continued involvement in this important issue.
ISCD Working to Restore DXA Reimbursement in Medicare Package.
In the past several weeks, ISCD and our coalition partners have been reinforcing the message on DXA with key committee members in the House and Senate. Now that the government shut-down has been resolved, we need each of you to contact members of Congress on DXA to reinforce that message.
Congress should finalize a Medicare package before the end of the year. DXA needs to be included in that proposal. Your efforts are critical to our success. Members of Congress need to hear from their constituents about the importance of DXA testing and that inadequate reimbursement is hampering access to this important test.
Please take just a few minutes to click here and send a pre-drafted email on this important issue. Of course, if you are willing to help with meetings, op-eds and other grassroots efforts, we would love to hear from you.
In Nebraska, ISCDs letter to the editor was published in response to the Omaha World Herald article by Rick Ruggles, “Medicare Reimbursing Less for Osteoporosis Scans.” A portion of Ruggles article is provided below.
Thanks again for your continued assistance with this important grassroots campaign. Please email me if you are willing to be involved in our media efforts. If you have questions, please contact ISCD Legislative Counsel, Donna Fiorentino at 860-402-2159 or email@example.com.
Medicare reimbursing less for osteoporosis scans
By Rick Ruggles / World-Herald staff writer
November 3, 2013
Doctors have an effective way to scan bones for osteoporosis and the risk of fractures, but Medicare is paying less and less for those scans when they are done in doctors’ offices.
Lower reimbursement appears to have resulted in fewer doctors providing the service, meaning some patients who could take medicine to prevent bone loss might go undiagnosed. The Medicare system will save money for the short term, some experts say, and rack up greater costs in the treatment of hip, back and wrist fractures over the long term.
Last modified: June 6, 2019