Mountain State Medical Policy Bulletin

Section: Radiology
Number: X-8
Topic: Stress Films and Weight Bearing X-rays
Effective Date: August 1, 2005
Issued Date: August 1, 2005
Date Last Reviewed: 06/2005

General Policy Guidelines

Indications and Limitations of Coverage

An additional allowance is not paid for stress films or weight bearing x-ray studies when performed in conjunction with conventional x-ray studies of the same body area (e.g., spine, hip, knee, ankle). When both conventional x-ray studies of an extremity or joint and stress films or weight bearing x-ray studies are reported and billed separately, the charges are combined under the appropriate procedure code for the conventional x-ray study reported. When only stress films or weight bearing x-rays are performed, use the appropriate code for a limited x-ray of the anatomic area.

Procedure code 76006 represents manual application of stress performed by a physician for joint radiography, including the contralateral joint if indicated. Code 76006 must be reported with the appropriate procedure code for the conventional x-ray study performed. If code 76006 is reported without the appropriate conventional x-ray code, it will be denied. A participating, preferred, or network provider cannot bill the member for the denied service in this situation.

Procedure Codes

76006     

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

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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.