When certain diagnostic imaging services or procedures are performed for the same patient during the same imaging session on the same date of service, payment will be made at 100 percent for the imaging procedure with the highest allowance. For additional imaging services performed on contiguous anatomic areas during the same imaging session, payment for the technical component portion only will be reduced to 75% of the allowance for the technical component. 

The Procedure Code Attachment located at the end of this policy provides a reference list of the eleven (11) imaging groupings of codes that are subject to this technical component payment reduction. Each grouping is based on the imaging modality used and contiguous body areas. 

When multiple imaging services within the same grouping are performed on the same day for the same patient, but at different imaging sessions, modifier -59 must be reported for the subsequent session(s). 

For additional information on multiple diagnostic x-ray studies performed in the same day, refer to Medical Policy Bulletin X-11. 

Description

When certain diagnostic imaging services or procedures are performed for the same patient during the same imaging session on the same date of service, payment will be made at 100 percent for the imaging procedure with the highest allowance. For additional imaging services performed on contiguous anatomic areas during the same imaging session, payment for the technical component portion only will be reduced to 75% of the allowance for the technical component.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

Centers for Medicare and Medicaid Services

Medlearn Matters #SE0587, SE0665