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    FFR & Reimbursement: What Cardiologists & Coders Should Know

    August 31, 2012

    Following publicity around FAME 2, many cardiologists and their coding staff may have questions about reimbursement for fractional flow reserve (FFR). SCAI fought for add-on payments for the use of FFR technology, succeeding in obtaining CPT® code 93571 and the additional payment average allowed charge of $91 but not in getting additional payments for hospitals. Although SCAI leveraged the support of a CMS-convened hospital payment advisory board, the agency continues to say FFR is a bundled procedure included in the facility's inpatient and outpatient payment rates.

    SCAI data analysts have noted a small but rapidly growing number of FFR procedures being billed to Medicare, rising from 22,000 in 2010 to 28,000 in 2011. It may be that some coding staff are assuming that a procedure not separately billable for the hospital is not separately billable by the physician. SCAI suggests checking with coding staff to ensure they are billing for FFR whenever it is used.