Radiology Gets a Smaller Slice of the MPFS Pie

Gregory N Nicola, MD, FACR; Lauren P Golding, MD


Appl Radiol. 2021;50(1):28-30. 

In This Article

Stakeholder Response

The American Medical Association (AMA), the proprietor of the Current Procedural Terminology (CPT) coding process, was one of the largest and most powerful objectors of the proposed reduced payment structure. The AMA immediately engaged its vast expertise in defining, and subsequently valuing, medical encounters via the CPT editorial panel and the Relative Value Update Committee (RUC), respectively (both entities governed by the AMA). Shortly after the rule was proposed, the AMA convened a work group to offer a better solution to accomplish the goals of "Patients over Paperwork," as well as value these services at a level acceptable to the stakeholders. The product of the CPT process was much akin to the structure predating CMS's 2019 proposed rule encompassing "levels" of service, with one minor modification: levels 1 and 2 for new patients were combined, as they were felt to be clinically indistinguishable. The panel also significantly altered the CPT descriptor by no longer requiring extensive history and physical examination documentation, instead replacing this documentation with more straightforward medical decision making and time requirements in keeping with the "Patients over Paperwork" initiative.