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Medicare Changes Effective January 1, 2016

November 05, 2015

CMS released two bulletins for changes coming in the new year. Both changes are effective January 1, 2016 with an implementation date of January 4, 2016.

Payment Reduction for Computed Tomography (CT) Diagnostic Imaging Services

Beginning 2016, claims for CT scans described by related CPT codes that are furnished on non-NEMA Standard XR-29-2013-compliant CT scans must include modifier “CT” that will result in a payment reduction of 5 percent. The payment reduction increases to 15 percent starting 2017.

New and Revised Place of Service Codes (POS) for Outpatient Hospitals

CMS outlined two POS code updates, adding new POS code 19 for “Off Campus-Outpatient Hospital” and revising POS code 22 from “Outpatient Hospital” to “On Campus-Outpatient Hospital” with the following descriptions:

POS 19 Off Campus-Outpatient Hospital: A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.

POS 22 On Campus-Outpatient Hospital: A portion of a hospital’s main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.

efficientC always uses the most up-to-date codes to ensure claims are paid fast. Learn more about efficientC or give us a call at (800) 799-7469.

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