The American College of Radiology (ACR), in concert with the American College of Cardiology (ACC), the American Academy of Neurology (AAN), and the Society for Vascular Surgery (SVS), presented value recommendations for the four duplex codes below to the American Medical Association / Relative Value Scale Update Committee (AMA/RUC) meeting in April 2014:
93886: Transcranial Doppler study of the intracranial arteries; complete study
93888: Transcranial Doppler study of the intracranial arteries; limited study
93975: Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal content retroperitoneal organs; complete study
93976: Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study
These proposed values were approved by the RUC and shared with the Centers for Medicare and Medicaid Services (CMS) for inclusion in the 2015 Medicare Physician Fee Schedule (MPFS). However, upon release of the MPFS in October 2014, CMS did not accept the value recommendations proposed by the specialty societies and the RUC, but instead, lowered the values based on their own internal review.
In the ACR’s December 2014 comment letter to CMS, the ACR provided clinical rationale to support our original recommended values and requested that these codes be referred to the CMS Refinement Panel for further review and reconsideration. The Refinement Panel is comprised of a multispecialty group of physicians and representatives from each of the participating societies (ACR, AAN, SVS, and ACC), as well as a number of Medicare contractor medical directors. These physicians review and discuss the work involved in the procedure(s) and then independently value the work of the procedure. Dr. Ezequiel “Zeke” Silva, III and Dr. Edward Grant represented ACR on the Panel. CMS will consider the Refinement Panel’s recommendation, but is not required to revise the value.
Final values for these intracranial study and vascular study codes will be released with the 2016 Medicare Physician Fee Schedule in November 2015.