Medicare radiology Payment Requirements

Payment is as follows:

• Inpatient – PPS, based on the DRG
• Hospital outpatient departments – OPPS, based on the APC
• Rural health clinics/federally qualified health centers (RHCs/FQHCs) – All-inclusive rate, professional component only, based on the visit furnished to the RHC/FQHC beneficiary to receive the MRA. The technical component is outside the scope of the RHC/FQHC benefit. Therefore the provider of the technical service bills their carrier on the ANSI X12N 837 P or hardcopy Form CMS-1500 and payment is made under MPFS.
• Critical access hospital (CAH) –

oFor CAHs that elected the optional method of payment for outpatient services, the payment for technical services would be the same as the CAHs that did not elect the optional method - Reasonable cost.
o The FI pays the professional component at 115 percent of Medicare Physician Fee Schedule (MPFS).
Deductible and coinsurance apply.