2010 MPI CPT Codes: Assessing
the Current Situation
The ACC has heard numerous complaints regarding the implementation of
the new bundled Myocardial Perfusion Imaging for SPECT and planar. The
issues center on the accepted level of insurer RVUs and how these new
codes will affect existing contracts and fee schedules. The College continues
to ask practices to examine their provider contracts for any language
discussing CPT changes and notification periods for such changes. We encourage
members to hold the payers to the existing contracts.
The ACC also has prepared a template
letter for providers to send to health plans regarding the changes
to SPECT-MPI coding. The letter template, which can be found in the ACC
Practice Survival Toolkit, has
three goals: 1) to inform payers of the new SPECT-MPI codes; 2) to express
the importance to correctly input and implement the new codes; and 3)
to request a date and time to discuss reimbursement for the new SPECT-MPI
codes for 2010. It provides a detailed table created by the American Medical
Association and the ACC that explains the four new nuclear cardiology
CPT codes for 2010, in addition to showing the relationship between the
2009 CPT codes and the new codes with their descriptors.
The new codes are a simplified and efficient way for providers to bill
for these cardiovascular diagnostic procedures. With the high utilization
volume of SPECT-MPI, it is essential for practices to emphasize the proper
implementation of these new codes by health plans.
Questions for reviewing your contract
- Is there language in the contract that governs the fee schedule? Is
this language linked to a specific year?
- Does the contract incorporate CMS changes automatically?
- Is reimbursement tied to Work RVUs only, or are practice expenses
and PLI also included?
- Does the contract require advance notice for fee schedule changes?
Tips for reviewing your contracts
Tip 1
Know the exact payment for each of the 2009 CPT codes that have been replaced
by the new 2010 bundled codes.
Tip 2
Know the exact cost to the practice for physician’s services. The
AMA document “Fee
Schedule Analysis: Using your complete practice cost as a guide”
contains a 12-step guide on how to create a practice fee schedule.
Tip 3
Ask for a copy of the health plan’s comprehensive fee schedule.
If the health plan does not provide it, insist on receiving a copy of
the top 20-50 most commonly billed cardiovascular procedures, including
detailed information on payment methodology. For more see AMA’s
“15
Questions to Ask Before Signing a Managed Care Contract.”
Tip 4
Forecast the practice’s total costs for the year, including overhead
costs and operating costs. Highlight any potential effects of decreased
payment to the practice’s viability.
Tip 5
Thoroughly explain your rationale for challenging the health plan’s
payment. Include appropriate documentation to support your request, such
as the cost to your practice to perform a service.
If your practice is experiencing problems receiving correct reimbursement,
please let the College know via the ACC's Payer
Hassle Factor Form.
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