What the 2007 imaging payment cap likely means to you

Why This Topic Matters

The topic is important for practices that furnish imaging and other services reimbursed under Medicare, because payment caps and fee schedule adjustments can materially change expected revenue. It is also useful for coding and billing staff who need to understand how national policy changes interact with site of service and locality-based payment calculations.

Article Sections

1. Imaging payment cap overview

   Introduces the 2007 Medicare imaging payment cap and summarizes the expected scope of its payment impact across service settings.

2. How the cap is analyzed and applied

   Discusses the payment framework used to estimate capped reimbursement and the general issues raised in applying the policy to different code types.

3. Example calculation using an imaging service

   Provides an illustrative payment example for an imaging service and compares capped and uncapped reimbursement in a specific locality.

4. Medicare’s Part B payment formula for 2007

   Reviews the 2007 physician fee schedule calculation steps and explains the role of locality-based adjustment factors in the payment formula.

5. Example calculation using an office visit

   Shows a second worked example using an office-based service to illustrate how the 2007 payment formula affects allowed amounts.