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