Although the proposed 2013 Medicare Physician Fee Schedule includes cuts to imaging and radiation therapy services, it does expand one aspect of imaging: some non-physician providers might now get paid for ordering portable X-rays.

Medicare regulations established in the late 1960s require the Centers for Medicare and Medicaid Services to only reimburse portable X-rays -- X-rays taken in someone's home, hospice or group living situation using a mobile system -- ordered by a medical doctor or a doctor of osteopathy.

Now, under new proposals released Friday, a range of physician and non-physician providers, from nurse practitioners and midwives to social workers, can also get paid for ordering the scans, as long as they're in compliance with state law and their Medicare statutory benefit.
"Non-physician practitioners have become an increasingly important component of clinical care, and we believe that delivery systems should take full advantage of all members of a health care team, including non-physician practitioners," CMS said in the proposed rules.

CMS said the change was initiated in part from provider feedback.

In December, the Office of the Inspector General found CMS was paying millions of dollars a year in reimbursements for portable X-rays ordered by non-physician practitioners, prompting the agency to issue a special report reminding providers that the services could only be ordered by an MD or a DO.

As a result, stakeholders told CMS that providers found the rule confusing, as Medicare generally reimburses non-physician practitioners for ordering other diagnostic tests, including lab tests and non-portable X-rays.

Covered by the proposed new rules are nurse practitioners, clinical nurse specialists, physician assistants, certified nurse-midwives, clinical psychologists and clinical social workers. Also included are doctors previously uncovered by the regulations, including doctors of optometry, dental surgery, dental medicine and podiatric medicine, CMS said.

However, CMS did say they were "concerned" by much of the questionable billing practices by portable X-ray suppliers turned up by OIG's December investigation, such as billing for multiple trips to the same facility on the same day, and billing for portable scans on a patient who also had a scan at a doctor's office or hospital on the same day.

"In conjunction with our proposal to expand the scope of physicians and non-physician practitioners who can order portable X-ray services, we intend to develop, as needed, monitoring standards predicated by these and other OIG findings," CMS said.

The comment period on the new rules runs until early September.

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