Radiology News
April 24, 2012 – Effective June 1, 2012, AmeriHealth New Jersey in collaboration with AIM Specialty Health, will begin collecting information about the imaging capabilities of all AmeriHealth-contracted providers in New Jersey who perform the technical component of advanced diagnostic imaging services (CT/CTA,MRI/MRA, Nuclear Cardiology, and PET Scans) for their New Jersey members. Information regarding imaging capabilities [...]
April 24, 2012 – Effective June 1, 2012, precertification will be required for most New Jerseymembers enrolled in AmeriHealth’s Commercial products for the following services: Stress echocardiography (SE) Resting transthoracic echocardiography (TTE) Transesophageal echocardiography (TEE) For the current version of this policy, click the following link: 09.00.46e, High-Technology Diagnostic Radiology Services.
April 24, 2012 – MA BCBS has qualified the following CT medical policies for the following policies: CT Scans;Whole Body CTand CT Perfusion Imaging – 009 Oncologic Applications of PET Scanning, 229 PET Scans, 358 The clarifications are as follows: Clarifying the listing of ICD-9-CM, 793.11 (solitary pulmonary nodule), and removing ICD-9-CM 518.89 (Other diseases [...]
April 24, 2012 – Effective June 1, 2012, the HUSKY Health Program and Charter Oak Health Plan’s radiology management program will include the requirement of authorization for non-emergent advanced imaging for CT/CTA,MRI/MRA, PET, PET/CT and nuclear cardiology studies when performed in an outpatient setting. The Community Health Network of Connecticut, Inc. (CHNCT) and Care to [...]
March 15, 2012Â Effective Date:Â June 1, 2012 BCBSIL will implement a change to the multiple procedure pricing of the technical component (TC) of professional claims for select diagnostic imaging procedures. BCBS will allow 100 percent for the SMA (Schedule of Maximum Allowance) for the highest priced procedure and 50 percent of the SMA will [...]
February 16, 2012 - OnFebruary 1, 2012, outpatient advanced imaging services for Health Management Associates (HMA) members enrolled in BCBSFL PPO products will require precertification. Services will include, MRIs, MRAs, CT Scans and Pet Scans. These members must request precertification by calling 888 – 376 – 6544. If precertification is not obtained, the claim will [...]
February 1, 2012 – On February 15, 2012, CMS will release a national provider report comparing a provider’s billing and payment patterns to those of their peers located in their state and across the nation. The reports are not available to anyone except the providers who receive them.  To ensure privacy, CMS will only [...]
January 23, 2012 – HPHC has updated their list of covered clinical indications to include ICD-9 code 427.9, cardiac dysrhythmia unspecified, for the following procedures effective with service dates beginningApril 1, 2012. Positron emission tomography (PET) cardiac scans Nuclear cardiac imaging and myocardial perfusion study For more information see the updated Positron Emission Tomography (PET) [...]
January 23, 2011 – BCBSMA has updated their Radiation Oncology fee schedule to include both a technical component reimbursement and a global reimbursement, retroactive to March 1, 2011 for code 77014 – Computed tomography guidance for placement of radiation therapy fields.  When billing for the technical component of this code, modifier TC should be used to [...]
January 23, 2012 – Effective,  January 1, 2012,  United Healthcare made changes to their procedure code list for Radiology Notification and Prior Authorization Programs.  The following seven new codes will be added to these lists. Descriptions of CPT codes are abbreviated.  74174 – CTA; abdomen & pelvis… 78226 – Hepatobiliary system imaging; including gallbladder [...]
December 30, 2011 – Reminder: Cigna has entered into an expanded relationship with MedSolutions, Inc. who will provide exclusive radiology benefit and network management services for Cigna and the GWH-Cigna network. MedSolutions will provide: Radiology Facility credentialing A utilization program featuring Predictive Radiology Intelligence Network Management services Reimbursement of low-technology radiology services provided within the [...]
December 30, 2011 – This is a reminder that Aetna will follow Medicare’s advanced accreditation program. Aetna will deem the following entities eligible for payment for the technical component of advanced diagnostic imaging procedures only if they are accredited by either the American College of Radiology (ACR) and/or the Intersocietal Accreditation Commission (IAC) Independent diagnostic [...]
December 30, 2011 – Most carriers will be adding the new CPTcode 74174 (Computed tomography angiography, abdomen and pelvis, with contrast material(s), including non-contrast images, if performed, and image post processing), for preauthorization through their diagnostic imaging management programs. The following carriers have published their intentions to add this code along with the effective date. [...]
November 17, 2011 – Effective January 1, 2012, upon renewal of all HMO, POS and PPO plans, Tufts will increase the copayment by $25 for CT/CTA, NRI/MRA, Nuclear Cardiology and PET Scan imaging tests. Members will be exempt from paying the high-tech imaging copay when the imaging is required as part of an active treatment [...]
November 17, 2011 – Effective January 1, 2012, HPHC will retire its Epidural Steroid and Transforaminal Injections Payment Policy and replace it with a new Epidural Steroid Injections for Low Back Pain Medical Policy. Under this new policy, epidural steroid injections are only considered medically necessary for the treatment of radicular low back pain.  [...]
November 17, 2011 – In a notice sent out by the Illinois Department of Healthcare and Family Services (HFS) on November 4th, 89 Illinois Administration Code, section 140, 438 has been revised to allow IDTFs to enroll as providers with the HFS Medicaid Programs. Enrollment forms must be completed along with a W9 and a copy of [...]
November 17, 2011 – Reminder:  For most IL BCBS members, obtaining a Radiology Quality Initiative number through AIM is required for advanced radiology imaging studies. However, the City of Chicago requires that all of its members, including non-Medicare retirees, submit a request for determination of medical necessity through Telligen for approval of CT, MRI and [...]
October 21, 2011 – HPHC has updated their list of covered clinical indications for the following procedures: Â Consistent with National Imaging Associates clinical coverage criteria: PET Scans Nuclear cardiac imaging and myocardial perfusion study Consistent with CMS policies Transthoracic Echocardiography (TTE) Viral hepatitis serology testing The updates are comprised of multiple changes including newly [...]
October 21, 2011 – Florida’s Agency for Health Care Administration has contracted with MedSolutions to authorize advanced outpatient diagnostic imaging services for Medicaid recipients. These services include CT, CTA, MRI, MRA and PET studies. Although the effective date is December 1, 2011, MedSolutions will begin to accept authorization requests as of November 14, 2011.  [...]
September 21, 2011 – On September 26, 2011, BCBS of Florida introduced a new transparency tool, “Know Before You Go,” to allow members to compare the cost and quality of health services before they receive them. The quality information is based on hospital data reported by CMS which is available to the public.  There [...]
October 21, 2011 – In order to expedite the processing of diagnostic imaging exam requests, American Imaging Management (AIM) will no longer support requests via fax beginning January 1, 2012. All diagnostic imaging requests submitted on and after January 1, 2012 should be submitted online through AIM’s ProviderPortalSM or via telephone. Faxing will continue to [...]
September 21, 2011 – In April 2011, BCBS of Illinois asked high-tech imaging service (CT/CTAs, MRI/MRAs, Nuclear Cardiology and PET scans) providers to complete AIM’s online OptiNet® assessment by June 3, 2011, which would gather modality-specific information in the following areas: staff qualifications, equipment accreditation, equipment specifications, and policy and procedures. The assessment data would [...]
September 21, 2011 – Code 78607, brain imaging, tomographic (SPECT) will be denied as “experimental and investigational” when billed with diagnosis code 088.81 (Lyme Disease). Refer to Clinical Policy Bulleting #0215 on Aetna’s website. This policy takes effect on December 1, 2011.
August 17, 2011 – Blue Cross of Northeastern Pennsylvania (BCNEPA) has entered into an agreement with National Imaging Associates, Inc. (NIA) to implement a radiology benefit management program. Effective November 1, 2011, this proÂgram includes the management and prior authorization of non-emergent, advanced, outpaÂtient radiology services for both First Priority Health® (FPH) and First Priority [...]
August 17, 2011 – Anthem BCBS has revised their medical policy to consider interim PET scanning during a course of treatment to evaluate response to treatment as investigational and not medically necessary (note: Interim PET scanning is not considered restaging). The policy was also updated to consider PET Mammography (PEM) for the detection of breast [...]
August 17, 2011 – Humana will be implementing a new imaging procedure policy for Humana commercial products that impacts multiple radiological procedures performed during the same visit. This policy is already in place for their Medicare products First, the technical component of the claim will be paid at 100 percent for the first service, with [...]
August 17, 2011 – The following changes are effective for claims adjudicated on or after October 1, 2011: Tufts Health Plan will not compensate for the professional component (modifier 26) or consultation (76140) when billed with a radiology procedure performed in the office setting and in conjunction with an Evaluation and Management service. Tufts Health [...]
August 17, 2011 – The local coverage determination (LCD) for magnetic resonance angiography (MRA) was most recently revised on October 1, 2010. The “CPT/HCPCS Codes” section of the LCD has also been revised to add a section, “CPT/HCPCS Codes that Do Not Support Medical Necessity”. This notification serves as a 45-day notice that the procedures [...]
August 20, 2011 – Effective September 1, 2011, ConnectiCare will make changes to their Radiology policy for In-Office services for both Commercial and VIP Medicare Plans. You may view the listing of codes that will be reimbursed when performed in an in-office setting by clicking below.  Connecticare InOffice Codes
August 17, 2011 – The Professional/Technical Component Policy requires medical documentation when a physician or other health care professional believes the professional component (modifier 26) is reimbursable in addition of the Evaluation and Management (E/M) service. Radiologic codes that describe fluoroscopic or ultrasonic guidance for placement of a needle, catheter, or tube are excluded from [...]
August 18, 2011 – CIGNA has entered into an expanded relationship with MedSolutions, Inc. (MSI), who will now provide exclusive radiology benefit and network management services for CIGNA, including the GWH-CIGNA network. The implementation will occur through a phased-in approach, beginning July 1, 2011. Health care professionals who are affected by this change should have [...]
July 20, 2011 – Effective September 1, 2011, BCBSRI will combine the existing 11 advanced imaging families into one family similar to the Centers for Medicare and Medicaid Services (CMS). Therefore, multiple procedure payment reduction (MPPR) applies when two or more services identified byCMSare furnished to a patient in a single imaging session. The MPPR [...]
July 20, 2011 – Effective January 1, 2012, Florida BCBS joins CMS and several other insurance carriers requiring accreditation through either the American College of Radiology (ACR) or Intersocietal Accreditation Commission (IAC) for receiving payment for AIS services. Consistent with this requirement, effective January 1, 2012, the National Imaging Associates (NIA) will not issue pre-authorization [...]
June 16, 2011 Enhancement to OptiNet® Empire BCBS in collaboration with American Imaging Management (AIM) is introducing an enhancement to OptiNet. When a provider requests a diagnostic imaging service, the site score for the local imaging provider or facility is based on general modality pricing along with other factors. Effective, June 27, the cost values [...]
June 16, 2011 – Mass Blue Shield has recently announced that they will maintain their current overall level of provider reimbursement for the fee schedule update to take place on September 1, 2011.  BCBSMA will also lower the conversion factor for Radiologists to begin bringing greater consistency between the standard conversion factor and that for [...]
June 16, 2011 – Effective July 1, 2011, United HealthCare will add CPT code 76498, an unlisted MRI procedure sometimes used for billing MRI thermographies, to their list of unproven thermography procedures stating there is insufficient evidence to conclude that thermography has a beneficial impact on health outcomes. United Healthcare states the available evidence is [...]
June 16, 2011 – The following procedure codes will be considered incidental when billed with either G0166 (external counterpulsation) or 92971 (cardioassist). 93922 – Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries 93923 – Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries; three or more levels
June 16, 2011 – Hiring RPAs/RAs (Radiology Assistants) has become more common in the radiology community and several articles have recently been published concerning billing for the RPA services. In the May-June 2011 RBMA Bulletin, they addressed a case study performed by Medical Management Professionals, Inc. (MMP), who tested the feasibility of Medicare paying for [...]
May 20, 2011  Multiple Radiology Reduction – Technical Component Effective Date of Service: Not yet Published  Consistent with CMS, Empire BCBS modified the multiple radiology reduction reimbursement by no longer assigning radiology procedures to separate radiology families but rather all radiology procedures for which this cutback is applicable have been assigned to a single family. The [...]
May 20, 2011 Prior Authorization Effective July 1, 2011  Computed tomographic angiography (75574) will be added to the list of imaging codes requiring prior authorization.  Updated: Multiple Imaging Reduction Procedures List  Effective Date: July 1, 2011 Tufts will follow the recent changes to the Multiple Imaging Reduction procedures published by CMS by [...]
May 20, 2011 – In August of last year, MABCBS implemented the multiple policy reduction for services on the same day for both the technical and the professional component. This policy reduced the second or subsequent imaging services by 50% for CTs, CTAs, MRAs, MRIs and ultrasound. The multiple imaging reduction policies of CMS (Medicare) and most other [...]
May 20, 2011 – Beginning April 18, 2011, BSBS of Illinois is asking high-tech imaging service providers to complete AIM’s online OptiNet® assessment, which will gather modality-specific information in the following areas: staff qualifications, equipment accreditation, equipment specifications, and policy and procedures. Your assessment data will be analyzed to determine a site score for each [...]
May 20, 2011 – Effective May 6, 2011, BCBSF consolidated the current 11 advanced imaging code families into a single code family.  Reimbursement for second and subsequent CT scans, MRIs or ultrasounds on the same service date will be reduced by 50 percent for the technical component. BCBSF will pay the full technical allowed amount for the procedure [...]
May 20, 2011 – Following CMS’ policy, United Healthcare no longer covers PET scans through National Oncologic PET Registry (NOPR) Coverage with Evidence (CED) trials. Physicians and facilities should bill their local carriers and intermediaries who will make payments on behalf of Medicare Advantage organizations directly to PET scan providers on a fee-for-service basis.  [...]
May 20, 2011 – In April 2011, the OIG released their findings on a study conducted on 2008 Medicare allowed claims for CT,MRIand x-rays performed in hospital emergency departments to see if they met the following three objectives: followed Medicare documentation requirements were performed before beneficiaries left the hospital outpatient emergency departments, and followed the [...]
May 20, 2011 – The current National Correct Coding Initiative (NCCI) edits that bundle the stand-alone CT abdomen (74150-74170) and CT pelvis (72192-72194) procedure codes with the combined CT abdomen and pelvis codes (74176-74178) will be modified by CMS as reported in the ACR’s Radiology Coding Source, March/April 2011 edition. Currently, the edits do not [...]
May 19, 2011 – Per an article in the ACR’s March/April 2011 volume of the Radiology Coding Source, radiology should expect more code bundling (combine multiple codes into a single code) in 2012 and continuing into the near future until alternate payment models are designed and implemented by CMS.  The ACR states they are [...]
April 20, 2011 – The following nuclear cardiac services (SPECT) will require precertification: 78466 – 78499 – Cardiac blood pool imagings and myocardial PET perfusion
April 20, 2011 – Effective with claims submitted with the service date of July 1, 2011, Cigna will adopt the following multiple imaging reduction policy. The highest allowable reimbursement amount will be paid at 100% of the fee schedule, maximum reimbursable charge or usual and customary rate, while all subsequent procedures will be subject to [...]
April 20, 2011 – Historically, Horizon BSBCNJ contracted directly with individual radiologists who practice at freestanding radiology centers but did not contract with the radiology center. Â In 2011, Horizon will begin to contract directly with select freestanding radiology centers and cease contracting with individual radiologists, stating they will create a freestanding radiology center network [...]
April 20, 2011 – When billing 3D studies, please keep the following in mind: Billing should be limited to those studies in which 3D rendering and complex post-processing are being performed The physician should be providing direct hands on supervision for processing of computerized CT, MRI, ultrasound, or other tomographic modality with 3D manipulation of [...]
March 2, 2011 – The new 2011 combination abdomen and pelvis CT codes were added to the list of codes for Prior Authorization for DX Imaging Services. 74176 – Computed tomography, abdomen and pelvis; without contrast material 74177 – Computed tomography, abdomen and pelvis; with contrast material(s) 74178 -Â Computed tomography, abdomen and pelvis; without contrast [...]
March 2, 2011 – In 2011, the CPT code 76880 (ultrasound extremity, nonvascular; real time with image documentation) was deleted and two new codes were created. 76881 – Ultrasound, extremity, nonvascular, real-time with image documentation; complete 76882 – Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific Now that there is a code for [...]
March 2, 2011 – BeginningAugust 12, 2011, if the referring physician does not obtain precertification,Aetnawill no longer cover the in-network benefits level for services provided by the following nonparticipating providers: Radiologists Pathologists Anesthesiologists Independent laboratories The policy applies to services performed in an office or independent laboratory setting. Even if patients have out-of-network benefits, a [...]
March 2, 2011 – On February 1, 2011, Aetnaimplemented a policy that would reduce the second and/or subsequent multiple imaging services by 50%, similar to CMS’ policy except that the reduction will apply to the technical and global charges.  Reducing the global charges will result in also reducing the professional component piece of the global charge for [...]
March 2, 2011 – As was to be expected, commercial carriers are beginning to adopt CMS’ January 1st,  multiple imaging reduction policy which: eliminated the use of the eleven (11) diagnostic imaging families so that all imaging codes are treated as if they are from the same family and applied the multiple imaging reduction to multiple CT,MRIand ultrasound [...]
February 16, 2011 – Effective immediately, ICD-9 covered indication codes V85.41 – V85.45 (Body Max Index 40 years old and over), will now be paid. HPHC Nuclear Cardiac Payment Policy
March 2, 2011 – On February 4, the FDA approved the first diagnostic radiology app that will allow physicians to view medical images on Apple’s iPhone and iPad. The product, which is designed to use with Apple products, is the Mobile MIM made by Cleveland-based MIM’s Software. The Mobile MIM will allow Radiologists to view images and make medical [...]
