Decrease in Ultrasound Reimbursement
Medicare has come up with a somewhat sneaky way to reduce your reimbursement for bilateral and unilateral duplex ultrasounds (codes 93970 and 93971). Here’s how:
In 2006, Medicare implemented the Outpatient Prospective Payment System (OPPS) to curb facility based outpatient reimbursement which includes ultrasound services. Unfortunately for the individual physicians, Medicare has extended that OPPS program to some services rendered by physicians at an in-office setting.
For phlebology practices, the most noticeable result is a reduction in the technical component reimbursement by Medicare for the above ultrasound services. The technical portion is being reduced by approximately 50% or a total reduction of about 25% dependent upon your geographic area. This reduction started this past year and may only now be noticed dependent upon your Medicare service area.
The only good news to this story is that commercial payers still use RBRVS (Resource Based Relative Value System — or Really Bad Reimbursement Very Slowly) as their basis for payment and do not use the OPPS model for re-calculating your reimbursement. As such, commercial payers have not followed Medicare in reducing reimbursement for duplex ultrasounds.
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