Congress Passes Bill to Avert Medicare Cuts
A number of payment cuts for physician practices amounting to a combined 9.75% were scheduled to go into effect on January 1, 2022. On December 7, 2021, the U.S. House passed S. 610, Protecting Medicare and American Framers from Sequester Cuts Act, which appears to have averted much of the scheduled 9.75% Medicare payment cuts. The House passed the bill by a vote of 222-212 and will prevent billions of automatic Medicare cuts from taking effect. The Senate followed suit on December 9th, in a 59-35 bipartisan vote. President Biden is expected to sign the bill very soon. We will continue to monitor the legislation to evaluate the effect on DXA reimbursement rates.
The ISCD Continues Work to Increase DXA Payment Rates
- In 2022, reimbursement for DXA is scheduled to be $36.96 in the office setting and $120.60 in the hospital setting.
- Payment for DXA and VFA performed on the same day (CPT 77085) is $50.73 in the office setting and $125.64 in the hospital setting.
- Reimbursement for VFA alone (CPT 77086) in the office is $32.59 and $90.67 in the hospital setting.
As part of the Fracture Prevention Coalition, the ISCD is working to ensure access to DXA testing by increasing the office-based reimbursement rate. We are pleased to report that The Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2021 has again been introduced in both the House and Senate to address this growing problem. The bill would increase DXA in the office setting to approximately $98.
Rep. John B. Larson (CT-01) introduced the HR 3517 with Reps. Linda Sánchez (CA-38), Lori Trahan (MA-03), Michael Burgess M.D. (TX-26), and Jackie Walorski (IN-02) and Sen. Susan Collins (R-ME) introduced S. 1943 with Sen. Cardin (D-MD), Sen. Marshall (R-KS), Sen. Stabenow (D-MI), Sen. Capito (R-WV), Sen. King (I-ME), Sen. Cassidy (R-LA), Sen. Sinema (D-AZ), Sen. Menendez (D-NJ), Sen. Rosen (D-NV).
As you may know, fractures caused by osteoporosis are among the most significant challenges threatening the independence and quality of life for older Americans. We have continued our grassroots advocacy efforts around the country to build support for these critical legislative proposals. We have created a new website at www.fracturepreventioncoalition.org that contains a variety of resources, including infographics with terrific statistics, key state charts and other important information. You can also share your own personal story via a link on the page that could be used in our advocacy efforts.
At present there are 57 cosponsors in the House and 12 in the Senate. We need your help in contacting members of both chambers today to urge their support of HR 3517 and S. 1943.
Please click here to send a message to members of your state delegation urging their co-sponsorship of these critical proposals. For more information, or to share your story, please contact email@example.com.
CMS Issues Correction re: Reimbursement for Trabecular Bone Score
The Centers for Medicare and Medicaid Services have issued a correction regarding the reimbursement for Trabecular Bone Score (77089). Effective January 1, 2022, the national average reimbursement for this code in the office setting will be $41.53 and $82.61 in the hospital setting. See below for detailed description of the family of TBS codes.