Health Economics
 
We have some exciting news to share.
 
On May 20, 2015, Congressman Dr. Michael Burgess (TX-R) introduced a new piece of federal legislation, HR 2461, titled The Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2015. 
     
•   If enacted, this legislation would establish a minimum national payment for DXA (CPT 77080) equal to $98 under Medicare Part B.
•   This rate is on par with the one Congress established in 2010, when a two year relief in Medicare payment cuts was provided for DXA. 
•   In July, 2010, Medicare began paying an additional $35 per DXA scan, as required by the Affordable Care Act.
     
The legislation would also establish minimum national Medicare payment for DXA with Vertebral Fracture Assessment (VFA) (CPT 77085) equal to $133 and VFA via DXA (CPT 770086) equal to $35.
 
The table below compares the current 2015 Medicare national payment rates with the new rates should the legislation be enacted.
•   The change in payment rates applies to the physician professional payment and technical component when the procedure is performed in non-facility (office and freestanding) settings.
•   It is the technical component in the office / freestanding facility that has been greatly undervalued is what would be restored via the legislation.
 

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Note that if a DXA test is performed in the hospital outpatient department, the hospital would still get a facility payment under Medicare’s Ambulatory Payment Classification (APC) system.  For 2015, a facility’s APC payment rate for CPT codes 77080 and 77085 is $95.02.

HR 2461 has been referred to the relevant Committees of jurisdiction (House Energy & Commerce and Ways & Means) for consideration, and we are optimistic about passage of this legislation before the end of the year.  The bill has been endorsed by the American Association of Clinical Endocrinologists, the International Society for Clinical Densitometry, and the National Osteoporosis Foundation. 

We encourage you to inform your customers of this important piece of legislation and urge them to contact their Members of Congress to request their co-sponsorship of HR 2461. 

Your customers can find their lawmakers using the attached Member of Congress Lookup Tool.

See sample talking points below and attached sample template letter that customers can use when advocating for improvements in DXA reimbursement with Members of Congress:
     
•   DXA is the best means of measuring bone mass to predict fracture risk.
•   Cuts in Medicare Part B reimbursement began in 2007, and have now dropped to 75 percent of the 2006 level.
•   As a result, there has been a 12.9 percent decline in DXA providers overall and fewer technologists and physicians are taking courses and being certified to perform and read DXA scans. 
•   From 2008 to 2012, there have been over one million fewer DXA tests performed. 
•   These compelling data make a strong case for restoring access to a necessary preventative service that provides extensive public health and economic benefits.
•   I urge you co-sponsor HR 2461, The Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2015. 
 

Please reach out to me or your Health Economics manager with any questions.