Multiple Diagnostic Imaging Payment Reduction

February 1st, 2018 - Wyn Staheli, Director of Research
Categories:   Billing   CPT® Coding  

CMS and some other payers have adopted policies of reducing payments when certain multiple diagnostic imaging procedures (see Applicable Codes below) are performed in a single session by the same healthcare provider and/or group. They have done the same when there are multiple units for a procedure code. The rationale is that since one imaging procedure has already been performed, much of the clinical labor activities and supplies (except film) are typically not performed or furnished twice and so are included with the primary service.

For Medicare, the most expensive imaging service is paid at 100% and all the others on their applicable code list are paid at the reduced amount. After January 1, 2017, the service(s) with the lower payment rate are paid at 95 percent. Note that this reduction does not apply to all imaging services, just to the codes listed below (for Medicare and UnitedHealthCare Oxford as of January 1, 2018). Be aware that applicable codes can vary by payer.

Exceptions:

  • The secondary procedure(s) are reported with the appropriate modifier (59 or XE) indicating that it was performed on the same date but during a different session. Note that switching rooms in the same facility does not count as a different session.
  • Multiple procedures are billed on the same day for the same patient but by DIFFERENT healthcare providers (as indicated by the NPI) during the same session.

Applicable Codes:

70336, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 70540, 70542, 70543, 70544, 70545, 70546, 70547, 70548, 70549, 70551, 70552, 70553, 70554, 71250, 71260, 71270, 71275, 71550, 71551, 71552, 71555, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72159, 72191, 72192, 72193, 72194, 72195, 72196, 72197, 72198, 73200, 73201, 73202, 73206, 73218, 73219, 73220, 73221, 73222, 73223, 73225, 73700, 73701, 73702, 73706, 73718, 73719, 73720, 73721, 73722, 73723, 73725, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74181, 74182, 74183, 74185, 74261, 74262, 74712, 75557, 75559, 75561, 75563, 75571, 75572, 75573, 75574, 75635, 76604, 76700, 76705, 76770, 76775, 76776, 76831, 76856, 76857, 76870, 77058, 77059, G0297

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