National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

MMR-2007 11AB, November 2007

Magnetic Resonance Imaging (MRI) Procedures

Provider Types Affected
Independent diagnostic testing facilities and other providers submitting claims to Medicare carriers, Fiscal Intermediaries (FI) and Part A/B Medicare Administrative Contractors (A/B MAC) for MRI services provided to Medicare beneficiaries

Provider Action Needed
Impact to You
Effective January 1, 2007, separate payment is made for the contrast media used in various imaging procedures. The cost of the contrast media is no longer included in the practice expense (PE) relative values units (RVUs) for the procedures.

What You Need to Know
In addition to the Current Procedural Terminology (CPT) code representing the imaging procedure, the appropriate Healthcare Common Procedure Coding System ( HCPCS) “Q” code (Q9945-Q9954; Q9958-Q9964) can be separately billed and paid for the contrast medium utilized in performing the service

What You Need to Do
Make certain that your billing staffs are aware of these changes. See the Background and Key Points sections of this article for further information.

Background
Prior to January 1, 2007, separate payment was not made for contrast media used in certain MRI procedures because the contrast media was included in the payment for the procedure. To read the complete change in the Medicare Claims Processing Manual, Chapter 13—Radiology Services and Other Diagnostic Procedures, see the Additional Information section of this article and click on the official instruction that was issued with CR5677. The key points of CR5677 are:

• Medicare FIs, carriers, and A/B MACs will pay separately for the contrast medium identified with the appropriate HCPCS “Q” code (Q9945-Q9954; Q9958-Q9964) used in performing various MRI procedures.
• Medicare FIs, carriers, and A/B MACs will not search their files for claims affected by this change to retroactively pay claims, but will adjust such claims that you bring to their attention that were denied with dates of service on or after January 1, 2007.

Additional Information
For complete details regarding this Change Request (CR) please see the official instruction (CR5677) issued to your Medicare carrier, FI or A/B MAC. That instruction may be viewed by going to http://www.cms.hhs.gov/Transmittals/downloads/R1339CP.pdf on the CMS Web site.

If you have questions, please contact your Medicare carrier, FI or A/B MAC, at their toll-free number which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

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