AMA Clinical Examples in Radiology - 2010 Bulletin 1
Anti-Markup Limitation on Diagnostic Tests Payments Expanded
Anti-Markup Limitation on Diagnostic Tests Payments Expanded The Centers for Medicare and Medicaid Services (CMS) finalized the anti-markup payment limitation by expanding the limitation to apply to both the technical component (TC) and the professional component (PC) of diagnostic tests when the physician performing the diagnostic test does not share a practice with the billing physician. The anti-markup limitation does not apply if: The billing physician and the performing physician share a practice. The performing physician furnishes substantially all (at least 75%) of his or her professional services through the billing physician. The TC or PC is performed or...
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Article Overview
This article summarizes a Medicare payment policy change from CMS involving the anti-markup limitation for diagnostic tests. It is aimed at physicians, billing staff, and coders who need to understand when the policy applies, the general circumstances that exempt a claim, and the documentation and claim-submission framework discussed by CMS. The article also points readers to CMS implementation guidance and addresses reporting considerations for diagnostic test components under the expanded policy.
Why This Topic Matters
The update affects how diagnostic test claims are submitted and how payment is limited in certain arrangements between the billing and performing physicians. It is relevant to practices that bill for diagnostic services and need to align claim handling with CMS policy.
What You Will Learn
- The CMS policy context for the expanded anti-markup limitation
- Which diagnostic test billing arrangements are affected in broad terms
- The general circumstances described by CMS where the limitation does not apply
- Claim-submission and documentation considerations discussed in the article
- Where the article directs readers to find additional CMS guidance
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice managers
- Radiology practices
- Compliance staff
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