CMS released Transmittal R1418CP, CR 5805 notifying PET facilities and Medicare Administrator Contractors that the discontinued QA, QR, and QV HCPCS modifiers have been replaced by the newly created 2008 modifiers Q0 (zero) and Q1 to identify investigational and routine clinical services provided in a clinical research study approved by Medicare.

Specifically, effective January 1, 2008, modifier QR currently used in the National Oncology PET Registry is replaced with Q0 (zero).

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Effective January 1, 2008, CMS implemented an Outpatient Code Edit (OCE) that will result in the return of (for correction) any claim for a nuclear medicine procedure that does not contain a HCPCS Level II radiopharmaceutical code.The HCPCS code for billing FDG is A9552.

Some Medicare cuts that would have been implemented on January 1, 2008 were delayed by the Medicare and Medicaid SCHIP Extension Act, signed by the President on December 29, 2007. This law provides a 0.5% Medicare payment increase for physicians for 6 months through June 30, 2008, averting the -10.1% conversion factor cut.

In addition, the Act extended for 6 months, payments to hospital outpatients at 2007 rates for brachytherapy and therapeutic radiopharmaceuticals, as well as extending for 6 months the 1.0 floor Geographic Practice Cost Indices (GPCI) for local adjusters in the physician fee schedule formula. The GPCI is a multiplier used to reflect different costs for different geographic areas in calculating payment allowables under the physician fee schedule.

View the national payment rates for 2008 published on the SNM website 

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UnitedHealthcare (UHC) has extended the effective date for freestanding imaging facilities to obtain accreditation as a condition for reimbursement. The original effective date of March 1, 2008 has been extended to the third quarter of 2008.

Beginning in the third quarter of 2008, UHC will require all freestanding facilities and physician offices performing outpatient imaging studies that bill on CMS 1500 claim form to obtain accreditation as a condition for reimbursement. The imaging modalities include CT, CTA, MRI, MRA, PET, Nuclear Medicine, Nuclear Cardiology, and Echocardiography.

To meet the third quarter 2008 deadline, UHC recommends applying for accreditation as soon as possible. UHC recognizes the American College of Radiology (ACR) and the Intersocietal Accreditation Commission (IAC) standards and has enlisted their expertise in facilitating accreditation.

Visit the Accreditation Tool Kit to learn practical information on the accreditation process from centers who have recently mastered the accreditation process.

Read newly published UHC Accreditation FAQs

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Providers continue to measure the impact of the DRA. But the news isn't all bad, especially for hospitals. Memorial Hermann saw an opportunity to build a new revenue stream and seized it.

While the doors of freestanding imaging centers are closing in response to the Deficit Reduction Act (DRA), opportunity is knocking for hospital imaging service line managers who understand the demands of this customer-driven market.

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The FDA said that the shortage of medical imaging isotopes is over and no further supply issues are expected, following the reopening of Canada's National Research Universal reactor at Chalk River, Ontario. The Canadian reactor is the major source of radioactive isotopes for imaging purposes in North America.

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