CurrentBlue Cross Blue Shield - MainePolicy G-06160

Portable/Mobile Radiology Reimbursement

Governs reimbursement rules for portable/mobile radiology services provided in a member's residence, including transportation and setup, handheld device billing, and supplier licensing; applies to AMH Health Medicare Advantage members and providers submitting claims to AMH Health.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyPortable/Mobile Radiology Reimbursement

Policy CodePolicy G-06160

Change TypeAdministrative reviews (no material changes)

Effective Date07/23/2021

Next Review Date

Key ActionOrder portable/mobile radiology services by a physician and ensure they are performed by qualified, licensed portable radiology suppliers meeting medical necessity criteria.

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.

01/01/2020, Policy History = Initial approval and effective

split costbilling rule for transportation at same location

no separate TChandheld radiology reimbursement stance

licensedsupplier requirement

equipment transportedtransportation eligibility

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Portable/Mobile Radiology Coverage Criteria

Conditions and billing rules for reimbursement:

Reimbursable when furnished in a residence used as the member's home, ordered by a physician, and performed by qualified portable radiology suppliers; suppliers must be licensed or registered as required by applicable state law.

Portable/mobile radiology studies should not be performed for reasons of convenience. Reimbursement is based on the applicable fee schedule or contracted/negotiated rate for the radiological service.

ALL of the following

Transportation and setup are reimbursable only when portable X-ray equipment was actually transported to the member's residence.
Reimbursement for transportation is a single payment for each location; when more than one member at the same location receives services, the transportation cost is divided by the total number of members receiving services at that location.
Reimbursement for setup cost of portable radiology equipment is separately reimbursable.
When more than one member receives portable radiology services, providers must bill according to the Related Coding section; no modifier is required when only one member is served.

ALL of the following

No reimbursement for transportation costs if equipment is stored at a residence for use as needed (i.e., not transported).
If the diagnostic X-rays are not covered, payment will not be made for the transportation and setup fee.

ALL of the following

Use of handheld radiology instruments is allowed; however, reimbursement for handheld devices is included in the physician's professional service and no additional charge will be paid.
Technical components for handheld radiology are not separately reimbursable.
When multiple patients are served at the same location, use the appropriate modifiers (UN/UP/UQ/UR/US and paired numeric modifiers) to divide transportation cost among members as described in policy.

Coding and Transportation Billing

Covered HCPCS/ModifiersModifierCovered

UN	Two patients served — paired numeric modifiers: UN, = Transportation cost is divided by two members.
UP	Three patients served — paired numeric modifiers: UP,1 = Three patients served; UP,2 = Transportation cost is divided by three members.
UQ	Four patients served — paired numeric modifiers: UQ,1 = Four patients served; UQ,2 = Transportation cost is divided by four members.
UR	Five patients served — paired numeric modifiers: UR,1 = Five patients served; UR,2 = Transportation cost is divided by five members.
US	Six or more patients served — paired numeric modifiers: US,1 = Six or more patients served; US,2 = Transportation cost is divided by six members (regardless of number of members served).

Transportation payment rule

Transportation payment ruleSingle payment per location; divide cost by number of members served when more than one. When only one member is served, no modifier is required.

Ordering, Medical Necessity, and Supplier Requirements

Note

Physician order and qualified supplier required

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

Obtain a physician order before performing portable/mobile radiology in a member's residence.
Verify the portable radiology supplier is qualified and holds any state-required license or registration.
Confirm services meet authorization and medical necessity requirements for the procedure, diagnosis, and member's state of residence.

Definitions

Portable Radiology Services — definition

DefinitionRadiological procedures provided with hand-carried or mobile radiological components in a member's residence when the member is unable to travel to a physician's office or outpatient hospital radiology department due to the member's clinical condition.

Included settingsMember's residence includes private home, assisted living facility, nursing facility, and intermediate care facility.

Also known asKnown as mobile radiology; referred to as Portable Radiology Services in this policy.