Proposed 2006 fee sked: You will no longer be able to refer patients for nuclear scans in facilities you or your practice own

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This premium article explains how a proposed 2006 Medicare fee schedule would affect nuclear imaging within cardiology practices, including self-referral concerns under Stark, facility ownership issues, reimbursement trends, and related billing considerations. It is aimed at cardiologists, cardiology practices, and coding/billing professionals who need to understand the general scope of the proposed changes and their operational impact. The article also touches on CMS guidance, Medicare payment policy, and changes affecting contrast material billing and multiple diagnostic imaging services.

Why This Topic Matters

Practices that furnish or refer nuclear imaging services need to understand proposed Medicare policy changes that could affect referral patterns, ownership arrangements, and reimbursement. The article helps readers evaluate whether the proposed fee schedule is relevant to their specialty and billing workflow.

Article Sections

  1. Proposed self-referral restrictions and nuclear imaging

    Discusses the proposed Medicare policy change related to nuclear medicine and physician self-referral. It outlines the broader compliance and ownership implications for cardiology practices.

  2. Options for practices under the proposal

    Summarizes the general response paths described for affected practices if the proposal is finalized. The section focuses on operational choices and practice-structure considerations.

  3. Other proposed payment changes affecting cardiology

    Covers additional Medicare payment changes discussed for cardiology services, including trends affecting imaging and EKG reimbursement. It also notes policy changes related to multiple procedures and contrast material billing.

  4. Medicare fees and cardiology utilization of select nuclear services

    Presents a data table showing utilization and fee trends for selected services across multiple years. This section provides context for the proposed payment changes without reproducing the underlying analysis.

What You Will Learn

  • How the proposed fee schedule may affect nuclear imaging-related referrals in cardiology practices
  • What types of compliance and ownership issues are raised by the proposal
  • Which broad categories of cardiology payment changes are discussed in the article
  • How CMS policy changes may interact with contrast material billing and imaging reimbursement trends

Who Should Read This

  • Cardiologists
  • Cardiology practice managers
  • Medical coders and billers
  • Compliance staff
  • Health care administrators

Codes Discussed

Code Ranges Discussed

  • CPT: 78000 SERIES
  • CPT: 78414–78499
  • CPT: 70000–76000
  • HCPCS LEVEL II: Q9958–Q9964

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