Highmark X-rays, Computed Radiography and Tomography Payment Update

March 2019 ~

Highmark has posted updates to its reimbursement policy for X-rays Using Film, Computed Radiography and Computed Tomography.

These updates can be seen below.

Modifier FX: X-ray Taken Using Film Effective January 1, 2017, service lines reporting X-ray services using film must include modifier FX.

Modifier FY: X-ray Taken Using Computed Radiography Technology/Cassette-Based Imaging Effective January 1, 2018, service lines reporting X-ray services using computed radiography cassette based imaging, must include modifier FY.

Modifier CT: Computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association standard Effective February 1, 2018, service lines reporting Computed Tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association (NEMA) XR-29-2013 standard, must include modifier CT.

Reimbursement Guidelines

The Plan will apply a reimbursement reduction of 20% to the approved allowance on the technical component (and the technical component of the global fee) for X-ray services furnished using film (modifier FX).

The Plan will apply a reimbursement reduction of 7% to the approved allowance on the technical component (and the technical component of the global fee) for X-ray services furnished using computed radiography cassette-based imaging (modifier FY).

The Plan will apply a reimbursement reduction of 15% to the technical component (and the technical component of the global fee) for Computed Tomography (CT) services furnished using equipment that is inconsistent with the CT equipment standard.

For additional billing information, references and guidelines, see CMS’ Online Manual Publication 100-04, Chapter 4, Section 20.6.13.

Source(s): Highmark;