What might reimbursements for proposed MRI safety CPT codes look like?
The Centers for Medicare and Medicaid Services (CMS) recently proposed six new codes related to the extra work required by providers to ensure patient safety during MRI exams, but information on potential payment rates was not shared at the time.
Prior to the final proposal’s release, the American College of Radiology reached out to CMS to offer their recommendations on payment rates for five out of the six the new codes. Recognizing how the changing landscape of MRI technology will affect the modality’s safety, ACR developed payment rates it felt fit the added workload involved in ensuring patient safety.
“Technological advancements in both the MRI scanner and in the design and testing of implants for MR safety have enabled many new implants to come to market with FDA-approved labeling specific to use in an MRI environment,” ACR said in the letter to CMS. “However, now that it has become possible to perform an MRI examination in the presence of some of these devices and implants, it is necessary to appropriately reimburse hospitals for the work performed once a potential contraindication is discovered.”
The payment rate suggestions are as follows:
$129.28 for CPT code 7XX00, which includes analyzing the current MR conditional status of individual components and systems of devices for an initial 15 minutes.
$129.28 for CPT code 7XX02, which covers the review of medical records by a physician or other qualified healthcare professional to identify contraindications and potential safety risks. This includes the review of implant MR conditions for an indicated exam, analysis of risk versus clinical benefit, and determination of MR equipment, accessory equipment, and the expertise required to perform an examination with a written report.
$352.05 for CPT code 7XX03, which relates to examination customization, planning and performance monitoring by a medical physicist or MR safety expert.
$352.05 for CPT code 7XX04, which addresses implant electronics preparation (programming a pacemaker, for example) under supervision of a physician or other qualified healthcare professional.
$352.05 for CPT code 7XX05, which Covers implant positioning and/or immobilization under supervision of physician or qualified healthcare professional, including application of physical protections to secure an implanted medical device from MR-induced vibrational forces, magnetically induced functional changes, and/or prevention of radiofrequency burns from inadvertent tissue contact while in the MR room.
MRI safety expert Tobias Gilk, MRSO, MR architect and founder of Gilk Radiology Consultants, who has been at the forefront of the push for safety requirements, previously told Health Imaging that CMS’ move to acknowledge the added burden MRI safety precautions put on providers could be an “important ’toe hold’ for future efforts at standardization.”
For now, both the codes and the suggestions on reimbursement rates are just proposals, as nothing has been finalized.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.