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Multiple Procedure Reduction of Certain Diagnostic Imaging Procedures Effective Nov. 1, 2013

July 26, 2013

Provider Types Affected

Physicians and suppliers billing for diagnostic imaging services

Background

  • The Multiple Procedure Reduction on diagnostic imaging applies when multiple services are furnished by the same provider to the same patient in the same session on the same day. 
  • Technical Component (TC) Services - Applies to both technical component (TC) only services and to the TC portion of global services on certain diagnostic imaging services.  Full payment is made for the service with the highest TC allowable.  Payment is made at 50 percent for the TC of subsequent services furnished by the same provider to the same patient in the same session on the same day. 
  • Professional Component (PC) Services - Effective Nov. 1, 2013, the Multiple Procedure Reduction will also apply to professional component (PC) only services and to the PC portion of global services.  Full payment is made for each PC and TC service with the highest allowable.  Payment is made at 75 percent for subsequent PC services furnished by the same provider to the same patient in the same session on the same day.  Payment is made at 50 percent for subsequent TC services furnished by the same provider to the same patient in the same session on the same day.
  • BCBSTX considers a single session to be one encounter where a patient could receive one or more radiological studies.  If more than one of the imaging services listed below is provided to the patient during one encounter, then this would constitute a single session and the lower-priced procedure(s) would be reduced.  If a patient has a separate encounter on the same day for a medically necessary reason and receives a second imaging service from the list below, then BCBSTX considers these multiple studies on the same day to be provided in separate sessions.  In the latter case, BCBSTX has established that the physician should use modifier -59 to indicate multiple sessions, and that the Multiple Procedure Reduction does not apply.

Multiple Procedure Reduction Code List Effective Nov. 1, 2013

70336

 

MRI temporomandibular joint(s)

70450

 

CT head/brain w/o dye

70460

 

CT head/brain w/ dye

70470

 

CT head/brain w/o & w/ dye

70480

 

CT orbit/ear/fossa w/o dye

70481

 

CT orbit/ear/fossa w/ dye

70482

 

CT orbit/ear/fossa w/o & w/ dye

70486

 

CT maxillofacial w/o dye

70487

 

CT maxillofacial w/ dye

70488

 

CT maxillofacial w/o & w/ dye

70490

 

CT soft tissue neck w/o dye

70491

 

CT soft tissue neck w/ dye

70492

 

CT soft tissue neck w/o & w/ dye

70496

 

CT angiography, head

70498

 

CT angiography, neck

70540

 

MRI orbit/face/neck w/o dye

70542

 

MRI orbit/face/neck w/ dye

70543

 

MRI orbit/face/neck w/o & w/dye

70544

 

MRI angiography head w/o dye

70545

 

MRI angiography head w/dye

70546

 

MRI angiography head w/o & w/dye

70547

 

MRI angiography neck w/o dye

70548

 

MRI angiography neck w/dye

70549

 

MRI angiography neck w/o & w/dye

70551

 

MRI brain w/o dye

70552

 

MRI brain w/dye

70553

 

MRI brain w/o & w/dye

70554

 

MRI brain by tech

71250

 

CT thorax w/o dye

71260

 

CT thorax w/ dye

71270

 

CT thorax w/o & w/ dye

71275

 

CT angiography, chest

71550

 

MRI chest w/o dye

71551

 

MRI chest w/ dye

71552

 

MRI chest w/o & w/ dye

71555

 

MRI angiography chest w/ or w/o dye

72125

 

CT neck spine w/o dye

72126

 

CT neck spine w/dye

72127

 

CT neck spine w/o & w/dye

72128

 

CT chest spine w/o dye

72129

 

CT chest spine w/dye

72130

 

CT chest spine w/o & w/dye

72131

 

CT lumbar spine w/o dye

72132

 

CT lumbar spine w/dye

72133

 

CT lumbar spine w/o & w/dye

72141

 

MRI neck spine w/o dye

72142

 

MRI neck spine w/dye

72146

 

MRI chest spine w/o dye

72147

 

MRI chest spine w/dye

72148

 

MRI lumbar spine w/o dye

72149

 

MRI lumbar spine w/dye

72156

 

MRI neck spine w/o & w/dye

72157

 

MRI chest spine w/o & w/dye

72158

 

MRI lumbar spine w/o & w/dye

72159

 

MRA spinal canal & contents w/ & w/o dye

72191

 

CT angiography, pelvis w/o & w/ dye

72192

 

CT pelvis w/o dye

72193

 

CT pelvis w/ dye

72194

 

CT pelvis w/o & w/ dye

72195

 

MRI pelvis w/o dye

72196

 

MRI pelvis w/ dye

72197

 

MRI pelvis w/o &w/ dye

72198

 

MRI angiography pelvis w/ or w/o dye

73200

 

CT upper extremity w/o dye

73201

 

CT upper extremity w/dye

73202

 

CT upper extremity w/o & w/dye

73206

 

CT angiography upper extremity w/o & w/dye

73218

 

MRI upper extremity w/o dye

73219

 

MRI upper extremity w/dye

73220

 

MRI upper extremity w/o & w/dye

73221

 

MRI joint upper extremity w/o dye

73222

 

MRI joint upper extremity w/dye

73223

 

MRI joint upper extremity w/o & w/dye

73225

 

MRA upper extremity w/ or w/o dye

73700

 

CT lower extremity w/o dye

73701

 

CT lower extremity w/dye

73702

 

CT lower extremity w/o & w/dye

73706

 

CT angiography lower extremity w/o & w/dye

73718

 

MRI lower extremity w/o dye

73719

 

MRI lower extremity w/dye

73720

 

MRI lower extremity w/ & w/o dye

73721

 

MRI joint of lower extremity w/o dye

73722

 

MRI joint of lower extremity w/dye

73723

 

MRI joint of lower extremity w/o & w/dye

73725

 

MRI angiography lower extremity w/ or w/o dye

74150

 

CT abdomen w/o dye

74160

 

CT abdomen w/ dye

74170

 

CT abdomen w/o & w/ dye

74174

 

CT angiography, abdomen & pelvis w/ dye

74175

 

CT angiography, abdomen w/o & w/ dye

74176

 

CT abdomen & pelvis w/o dye

74177

 

CT abdomen & pelvis w/ dye

74178

 

CT abdomen and/or pelvis w/o dye

74181

 

MRI abdomen w/o dye

74182

 

MRI abdomen w/ dye

74183

 

MRI abdomen w/o and w/ dye

74185

 

MRI angiography, abdomen w/ or w/o dye

74261

 

CT colonography w/o dye

74262

 

CT colonography w/ dye

75557

 

Cardiac MRI for morph

75559

 

Cardiac MRI w/stress imaging

75561

 

Cardiac MRI for morph w/dye

75563

 

Cardiac MRI w/stress imaging & dye

75571

 

CT heart w/o dye w/calcium test

75572

 

CT heart w/3d image

75573

 

CT heart w/3d image, congenital

75574

 

CT angiography heart w/3d image

75635

 

CT angiography abdominal arteries

76604

 

Us exam, chest, b-scan

76700

 

Us exam, abdomen, complete

76705

 

Echo exam of abdomen

76770

 

US exam abdomen back wall, comp

76775

 

US exam abdomen back wall, limited

76776

 

US exam kidney transplant w/Doppler

76831

 

Echo exam, uterus

76856

 

US exam, pelvic, complete

76857

 

US exam, pelvic, limited

76870

 

US exam, scrotum

77058

 

MRI, one breast

77059

 

MRI, both breasts

Example*

          Modifier

Procedure 1 (74183)

Procedure 2 (72196)

Multiple Imaging Allowed Effective 11/1/13

Professional Component

$158.66

$122.60

$250.61

{$158.66 (Proc 1 Prof) + $122.60 X 75% (Proc 2 Prof)}

Technical Component

$697.33

$533.65

$964.16

{$697.33 (Proc 1 Tech) + $533.65 X 50% (Proc 2 Tech)}

Global Component

$855.99

$656.25

$1,214.77

{$855.99 (Proc 1 Global) + ($533.65 (Proc 2 Tech) X 50%) + ($122.60 (Proc 2 Prof) X 75%)}

*Note: The allowables listed above are only examples.