I heard from a member who is having a problem with reimbursement.  He wrote:

It has recently come to my attention that diagnostic musculoskeletal ultrasound or CPT codes 76881 and 76882 are considered "designated health services" according to Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law and commonly referred to as the "Stark Law":

1.     Prohibits a physician from making referrals for certain designated health services (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship (ownership, investment, or compensation), unless an exception applies.

2.     Prohibits the entity from presenting or causing to be presented claims to Medicare (or billing another individual, entity, or third party payer) for those referred services.

3.     Establishes a number of specific exceptions and grants the Secretary the authority to create regulatory exceptions for financial relationships that do not pose a risk of program or patient abuse.

1.     Clinical laboratory services.

2.     Physical therapy services.

3.     Occupational therapy services.

4.     Outpatient speech-language pathology services.

5.     Radiology and certain other imaging services. 

6.     Radiation therapy services and supplies.

7.     Durable medical equipment and supplies.

8.     Parenteral and enteral nutrients, equipment, and supplies.

9.     Prosthetics, orthotics, and prosthetic devices and supplies.

10.  Home health services.

11.  Outpatient prescription drugs.

12.  Inpatient and outpatient hospital services.

(A list of the designated codes can be obtained at

https://www.cms.gov/PhysicianSelfReferral/40_List_of_Codes.asp#TopO...)

Currently, when I perform, interpret, and bill for a diagnostic study using these codes, I receive only 1/6th (I am in a 6-person medical group) of the reimbursement for those codes by Medicare. This is the same way that MRI is treated. 

However, when I order an MRI, all I do is write an order. When I order an MSK diagnostic ultrasound, I personally perform, interpret, and write the report.

Is his interpretation of the regulation correct? Can anyone offer clarification or recommendations?

Thanks,

Paula