Printer Friendly Version

Section: Radiology
Number: X-19
Topic: Radiographic Imaging Techniques
Effective Date: August 1, 2005
Issued Date: August 1, 2005
Date Last Reviewed: 06/2005

General Policy Guidelines

Indications and Limitations of Coverage

No additional allowance is paid for radiographic imaging techniques. When one of the procedures below is reported, the imaging technique is denied as not covered. A participating, preferred, or network provider cannot bill the member for the denied service. These codes are not representative of the actual radiological study being performed.

If only the code was reported and the radiological procedure was not specified, the claim will be developed for the radiological study performed.

Description

Cineradiography/Videoradiography (76120, 76125) is a rapid-sequence x-ray examination that films motion.

Digital Subtraction Angiography (DSA)
(S9022) is a computerized way of enhancing radiographic images. In digital subtraction, a computer "subtracts" a radiographic image taken before injection of an intravascular contrast material from one obtained with the contrast present. In the image produced using this technique, only contrast-filled vessels are visible.

Subtraction radiography (76350) is a technique used to eliminate overlying bone images which obscure the vascular pattern in an angiogram.

Videofluoroscopy (76499) is the recording on videotape of the images appearing on a fluoroscopic screen. (This is also referred to as dynamic motion imaging or dynamic motion x-rays.)

Xeroradiography (76150) is a system of developing images of specific areas of the body using x-rays. It differs from conventional radiography only in the nature of the recording medium that is employed.

Procedure Codes

7612076125761507635076499S9022

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Codes 76120, 76125, 76150, 76350, and S9022 are eligible for payment when reported independently.

Refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

PRN References

04/1999, Radiographic imaging techniques not covered

References

View Previous Versions

No Previous Versions

Table Attachment

Text Attachment

Procedure Code Attachment


Glossary





This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.



back to top