Reimbursement Policy Portable/Mobile/Handheld Radiology Services
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Governs reimbursement rules for portable, mobile, and handheld radiology services provided in a member's residence and related transportation/setup billing for Blue Cross Blue Shield - Nevada providers.
No material clinical or coverage changes in this revision.
Coverage and Reimbursement Criteria
Coverage criteria
Covered when ALL of the following conditions are met:
ALL of the following
- Service is furnished in a residence used as the member's home (includes assisted living, nursing facilities, etc.).
- Service is ordered by a physician.
- Service is performed by a qualified portable radiology supplier (licensed/registered as required by applicable state law).
- Service is not provided solely for routine convenience; portable/mobile radiology studies should not be performed for routine purposes or for reasons of convenience, except that preventive screenings using portable/mobile radiology are allowed.
- Transportation and setup reimbursement applies only when portable X-ray equipment was actually transported to the location where the X-ray was taken; setup cost may be reimbursed separately.
- Transportation reimbursement is based on a single payment per location; when more than one member receives services at that location the transportation cost must be divided among the members served and billed using the required modifiers (see Related Coding). No modifier is required when only one member is served.
- If diagnostic X-rays themselves are not covered, transportation and setup fees will not be paid.
Coding and Transportation Modifiers
| UN | Modifier for two patients served - divide transportation cost by two |
| UP | Modifier for three patients served - divide transportation cost by three |
| UQ | Modifier for four patients served - divide transportation cost by four |
| UR | Modifier for five patients served - divide transportation cost by five |
| US | Modifier for six or more patients served - divide transportation cost by six (regardless of number served) |
| No codes listed |
Ordering, Supplier Qualifications, and Authorization
Ordering and supplier qualifications for portable/mobile radiology
Portable/mobile radiology must be ordered by a physician and performed by qualified portable radiology suppliers; services should not be performed for routine purposes or for reasons of convenience. Reimbursement is based on the applicable fee schedule and may be subject to provider, state, federal, or CMS contract requirements that override this policy.
- Order must originate from a physician.
- Supplier must meet qualifications for portable radiology services.
- Do not perform portable/mobile studies solely for convenience or routine purposes.
Authorization and medical necessity requirements
Services must meet authorization and medical necessity guidelines appropriate to the procedure, diagnosis, and the member's state of residence; failure to follow billing, coding, authorization, or medical necessity requirements may result in claim rejection, denial, or recoupment.
- Ensure services meet authorization and medical necessity criteria before submission.
- Use proper CPT, HCPCS, and/or revenue codes that are fully supported in the medical record and/or office notes.
- Noncompliance may lead to claim rejection, denial, recovery/recoupment, or reimbursement adjustment.
Definitions
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