CurrentAnthemPolicy G-06160

Portable/Mobile/Handheld Radiology Services, Reimbursement Policy

Defines Anthem Medicare Advantage reimbursement rules for portable, mobile, and handheld radiology services provided in a member's residence, including transportation and setup reimbursement and limitations, for providers billing Anthem Medicare Advantage plans.

Policy Summary

PayerAnthem

PolicyPortable/Mobile/Handheld Radiology Services, Reimbursement Policy

Policy CodePolicy G-06160

Change TypeReview approved: no changes

Effective DateJul 23, 2021

Next Review Date

Key ActionServices must be ordered by a physician and performed by qualified portable radiology suppliers meeting authorization and medical necessity requirements.

SourceLink

POLICY UPDATE CHANGES

12/19/2023, Policy History = Review approved: no changes.

07/23/2021, Policy History = Review approved: no change to policy language; policy template updated.

single payment per locationTransportation reimbursement basis

transportation split by locationTransportation cost division

not reimbursedHandheld technical component

4 typesAllowed residences

Reimbursement Criteria

Policy Summary

PayerAnthem

PolicyPortable/Mobile/Handheld Radiology Services, Reimbursement Policy

Policy CodePolicy G-06160

Change TypeReview approved: no changes

Effective DateJul 23, 2021

Next Review Date

Key ActionServices must be ordered by a physician and performed by qualified portable radiology suppliers meeting authorization and medical necessity requirements.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Reimbursement criteria

Covered when ALL of the following are met:

Services furnished in a residence used as the member's home (private home, assisted living facility, nursing facility, intermediate care facility).

Ordered by a physician and performed by qualified portable/mobile radiology suppliers; suppliers must be licensed or registered as required by applicable state law.

Services meet authorization and medical necessity guidelines and are not performed solely for routine purposes or convenience.

Reimbursement is based on the applicable fee schedule or contracted/negotiated rate for the radiological service; transportation and setup components are reimbursable when equipment is transported to the member's residence.

ALL of the following

Examples of modifiers
- UN — two patients served (transportation cost divided by two).
- UP — three patients served (transportation cost divided by three).
- UQ — four patients served (transportation cost divided by four).
- UR — five patients served (transportation cost divided by five).
- US — six or more patients served (transportation cost divided by six).

Setup cost for portable radiology equipment is separately reimbursable when equipment is transported to the member's residence.

No reimbursement for transportation costs when equipment is stored at a location for use as needed (i.e., equipment kept on-site and not transported to perform a specific service).

If diagnostic X-rays are not covered, payment will not be made for the transportation and setup fee.

Handheld radiology instruments are allowed but reimbursement for handheld use is included in the physician's professional service; the technical component for handheld radiology is not separately reimbursable.

Transportation & Coding Rules

No codes listed

Transportation payment rule — Single transportation payment per location; cost divided among number of members served

Transportation payment ruleSingle transportation payment per location; when more than one member receives portable radiology services at the same location, the transportation cost is divided among the number of members served. Providers must bill using the appropriate UN/UP/UQ/UR/US modifier to indicate the number of members served. No modifier is required when only one member is served.

Ordering and Provider Qualifications

Prior Authorization

Physician order, qualified supplier, and authorization/medical necessity required

Services must be ordered by a physician and performed by qualified portable radiology suppliers. Providers must ensure services meet authorization and medical necessity guidelines appropriate to the procedure, diagnosis, and the member's state of residence. Portable/mobile radiology suppliers must be licensed or registered as required by applicable state law.

Order must be placed by a physician.
Service must be performed by a qualified portable radiology supplier.
Suppliers must be licensed/registered as required by state law.
Services must meet authorization and medical necessity guidelines appropriate to the procedure, diagnosis, and member's state of residence.

Residence Definitions for Portable Radiology

Portable/mobile radiology — residence definition

Definition of portable/mobile radiology servicesRadiological procedures provided with hand-carried or mobile radiological components in a member's residence when the member is unable to travel due to clinical condition.

Included residence: private homePrivate home is considered a member's residence for these services.

Included residence: assisted living facilityAssisted living facility is considered a member's residence for these services.

Included residence: nursing facilityNursing facility is considered a member's residence for these services.

Included residence: intermediate care facilityIntermediate care facility is considered a member's residence for these services.

Policy History & Changes

2023-12-19reviewLatest

Policy reviewed and approved with no changes to clinical policy language.

2021-07-23review

Policy review approved; no change to policy language; policy template updated.

2019-07-03review

Policy review approved; policy template updated.

2017-08-14review

Policy review approved.

2015-05-14review

Policy review approved; policy template updated.

2015-01-01initial_approval

Initial approval and policy effective date.