amichai...
The following page from R2Tech.com seems to address these
codes precisely. They list, as their accomplishments in
this area:
"Led efforts to secure Medicare reimbursement for CAD in
2001 and increase payment rates for 2002 and 2003
-Obtained CPT code (76085) for screening CAD effective in
2002 Expanded scope of CPT code (76085) to include
diagnostic CAD in 2003
-Led efforts to obtain Medicare coding and reimbursement
for CAD used with digital mammography for 2003
-Worked with over 400 local, regional, and national
commercial payors to secure coverage and reimbursement
for CAD"
With regard to the codes you inquired about, they say:
"Billing as a Freestanding Clinic: Medicare"
"As of January 1, 2004, providers can bill CAD with both
film screen and full-field digital mammography (FFDM) Bill
one of the following CAD codes as an add-on to the primary
mammogram code:"
"76083 - Computer-aided detection (computer algorithm analysis
of digital image data for lesion detection) with further
physician review for interpretation, with or without
digitization of film radiographic images, screening
mammography (list separately in addition to code for
primary procedure).
76083-TC - Technical component
76083-26 - Professional fee"
"76082 - Computer-aided detection (computer algorithm analysis
of digital image data for lesion detection) with further
physician review for interpretations, with or without
digitization of film radiographic images, diagnostic
mammography (list separately in addition to code for
primary procedure).
76082-TC - Technical component
76082-26 - Professional fee"
"Medicare Physician Fee Schedule (MPFS) 2003:The MPFS
final rule for 2003 has been published and will become
effective March 1, 2003. The global payment rate for
CAD (unadjusted National) has been increased to $19.13,
with the Professional Fee (-26) at $3.31, and the
Technical Component (-TC) at $15.82. Local reimbursement
rates will vary." [That last line would seem to indicate
that you should simply submit the codes, without a billing
amount, and the fees will be reimbursed according to the
schedule below, with variations based on locale].
"Medicare Physician Fee Schedule (MPFS) 2004: Instead of
the expected 4.5% decrease in the Medicare Conversion
Factor (MCF) for the Medicare Physician Fee Schedule
(MPFS), the MCF will be increased 1.5%. This will take
the global reimbursement rate for CAD to $19.04
(national average), $15.68 technical and $3.36
professional. Unfortunately the legislation did
nothing in regards to the Medicare Hospital Outpatient
Prospective Payment System (HOPPS). The national average
for diagnostic CAD done in a hospital outpatient setting
is decreasing from $25.00 to $8.31 for 2004."
They also provide a form on the same page for obtaining
more information on these topics:
http://www.r2tech.com/prf/prf003.html
The rates cited above seem authoritative, and in line with
(and slightly higher than) the rates on this page from the
Minnesota Department of Health's Sage Screening Program
rates for "Mammography - Computer Aided Detection (CAD)":
http://www.health.state.mn.us/divs/hpcd/ccs/mbcccp/rates.htm
The Minnesota rates seem solidified. Whether this is what
they have chosen to bill, or whether the rates are based on
their experience with submitting the codes and seeing how
much they are reimbursed, I honestly don't know.
Nonetheless, I believe I've provided you enough data to
decide upon and submit a charge based on the national
average, should you decide that naming a figure is the
way to go.
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Searches done, via Google:
76083 76082 medicare code reimbursement
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