Payment Policies - IAC CT

To date, the IAC is aware that the following insurers have adopted CT reimbursement directives, and provides this information as a service to the CT community. These policies are changed and updated regularly by the insurance carriers and list requirements as related to IAC accreditation only. Therefore, the IAC recommends that applicant facilities contact the insurance carriers in their area for the most accurate and current information to ensure compliance with reimbursement requirements at all times. Further questions about IAC accreditation as related to reimbursement may be directed to the IAC via e-mail.

Please Note: The policy details within this document listing accreditation requirements are only a portion of the full reimbursement directive, please search for the full policy by using the links provided within the documents.

Announcement for New York Facilities: New State Law Requires Facilities Performing CT to be Accredited

June 2016 | A state policy for New York that became effective on January 20, 2016 requires all New York facilities performing CT to be accredited within 18 months of the policy's effective date. All CT facilities must acquire accreditation by this date by a nationally recognized accrediting body that is acceptable to the New York State Department of State (NYCRR). The NYCRR has designated the Intersocietal Accreditation Commission (IAC) as an approved accrediting organization.

For details, visit https://regs.health.ny.gov/content/section-1659-use-computed-tomography-equipment.

Protecting Access to Medicare Act (PAMA)

The Protecting Access to Medicare Act (H.R. 4302; P.L. 113-93), also known as PAMA, enacted in 2014, amended the Social Security Act (the Act) to extend Medicare payments to physicians and other providers of the Medicare and Medicaid program. Section 218(a) of the Protecting Access to Medicare Act (PAMA) requires that ADI suppliers and hospital outpatient areas providing CT services must meet safety requirements under NEMA Standard XR-29-2013 beginning on January 1, 2016. ADI suppliers and hospital outpatient departments that are non-compliant with these safety requirements must use a Current Procedural Terminology (CPT) code modifier on their Medicare billing to attest to non-compliance. These non-compliant ADI suppliers will receive a decrease in their Medicare payment of 5% in 2016 with a further reduction to 15% in 2017 and thereafter.

FAQ - Computed Tomography (CT) Compliance Clarifications under Section 218(a)(1) of the Protecting Access to Medicare Act (PAMA)- Information Only

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