CurrentBlue Cross Blue Shield - NevadaPolicy G-06160

Portable/Mobile/Handheld Radiology Services

Reimbursement policy governing when and how Anthem Medicare Advantage (Blue Cross Blue Shield - Nevada) reimburses portable, mobile, and handheld radiology services provided in a member's residence or similar facility; applies to providers submitting claims for Anthem Medicare Advantage members.

Policy Summary

PayerBlue Cross Blue Shield - Nevada

PolicyPortable/Mobile/Handheld Radiology Services

Policy CodePolicy G-06160

Change TypeNo material change

Effective Date07/23/2021

Next Review Date

Key ActionOrder portable/mobile radiology studies by a physician and ensure they are performed by qualified portable radiology suppliers; follow billing guidelines to avoid recoupment.

SourceLink

07/23/2021policy dates

divided by members servedtransportation rule

tech not separately reimbursablehandheld stance

member residencescovered locations

Coverage Criteria and Billing Rules

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ALL of the following

Service furnished in a residence used as the patient’s home or specified facility and ordered by a physician
Performed by qualified portable radiology suppliers who are licensed or registered as required by applicable law
Not performed for reasons of convenience
Reimbursement determined by applicable fee schedule or contracted/negotiated rate for the radiological service, plus transportation and setup components
Transportation and setup reimbursed only when equipment is actually transported to the member’s residence; setup is separately reimbursable
If diagnostic X-rays are not covered, transportation and setup fees will not be paid
Handheld radiology
- Use of handheld radiology instruments is allowed
- Only the physician’s professional service is reimbursable for handheld radiology; technical components are not separately reimbursable
Transportation allocation when multiple members served
- Transportation reimbursement is a single payment per location divided by the total number of members receiving services at that location
- Providers must bill using the appropriate modifier to indicate the number of patients served when more than one member receives portable radiology services
- No modifier is required when only one member is served

Transportation Allocation and Coding

Transportation / Allocation ModifiersModifier

UN	Two patients served — transportation cost divided by two members.
UP	Three patients served — transportation cost divided by three members.
UQ	Four patients served — transportation cost divided by four members.
UR	Five patients served — transportation cost divided by five members.
US	Six or more patients served — transportation cost divided by six members (regardless of actual number served).

Ordering, Supplier, and Billing Compliance

Note

Ordering and Supplier Requirements — Physician order and qualified supplier

Orders for portable/mobile radiology services must be placed by a physician. Portable radiology suppliers must be qualified and, where required, licensed or registered to perform services under applicable law.

Orders must be from a physician.
Suppliers must be qualified and licensed/registered as required by law.

Billing Rule

Billing Compliance and Recoupment

Follow proper billing and submission guidelines and use industry-standard codes (CPT, HCPCS, revenue codes) that are fully supported in the medical record. Failure to follow coding/billing guidelines or current reimbursement policies may result in claim payment recovery/recoupment, claim rejection or denial, or reimbursement adjustments to reflect the appropriate services performed. Policies may be superseded by provider, state, federal, or CMS mandates; Anthem Medicare Advantage reserves the right to recover payments to the policy effective date when necessary.

Bill services with appropriate CPT, HCPCS, and/or revenue codes.
Ensure documentation in the medical record supports billed services.
Noncompliance may result in recovery/recoupment of payments, denial/rejection of claims, or adjusted reimbursement.

Definitions — Portable/Mobile Radiology

Definition of mobile/portable radiology and covered residence types

DefinitionMobile/portable radiology services are radiological 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

Covered residence typesPrivate home; Assisted living facility; Nursing facility; Intermediate care facility

Condition for useService applies only when the member cannot travel to a physician's office or outpatient hospital radiology department due to clinical condition

Transportation requirementServices reimbursed when the portable equipment is actually transported to the member's residence