CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Payment Policy Emergency room Radiology/Imaging Interpretation

Describes correct billing and reimbursement practices for radiology interpretations performed in the hospital emergency room by BCBSRI for applicable products; affects emergency physicians, radiologists, and billing staff submitting claims to Blue Cross & Blue Shield of Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyPayment Policy Emergency room Radiology/Imaging Interpretation

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 1, 2018

Next Review DateN/A

Key ActionEmergency room physicians should not bill a preliminary/wet read separately because the initial read is included in the E&M service; bill only a separate interpretation when a full written interpretation is maintained as a separate record.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2018-03policy effective month

2018-02-20policy last updated

Provider update Mar 2018publication

Benefits may varycoverage varies

Emergency Room Radiology Interpretation Coverage

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyPayment Policy Emergency room Radiology/Imaging Interpretation

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 1, 2018

Next Review DateN/A

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.

ER Radiology Interpretation Coverage Criteria

Coverage and billing rules for ER radiology interpretation services

Coverage and billing for emergency room radiology interpretation follow the rules below.

ALL of the following

ER physician initial read is included in the ER E&M service and should not be billed separately as a preliminary/wet read.
BCBSRI follows CPT guidelines that the emergency room physician should not bill a preliminary read (previously known as a wet read) separately as the initial read is included in the E&M service.

ALL of the following

Comprehensive, detailed review and interpretation of imaging completed in the emergency room should generally be conducted and billed by a board-certified radiologist.
The rendering of comprehensive detailed review and interpretation of the imaging completed in the emergency room in most instances should be conducted and billed by a board certified radiologist.

ALL of the following

If both an ER physician and a radiologist submit review/interpretation for the same imaging on the same date of service, the services may be treated as duplicate and the billing may be denied.
The review and interpretation on the same date of service by two providers will be treated as a duplicate service and may be denied.

Billing Guidance for Providers

Billing Rule

Do not bill preliminary/wet read separately; avoid duplicate interpretation claims

Emergency room physicians must not bill a preliminary (wet) read separately because “the initial read is included in the E&M service billable by the ER physician.” ER physicians may bill for an interpretation only when a full written interpretation is included and maintained as a separate record in the patient’s medical record. If both an ER physician and a radiologist submit review/interpretation for the same date of service, the second submission may be treated as a duplicate service and denied.

Do not submit a separate CPT/claim for a preliminary/wet read when the ER E&M includes the initial read.
Only bill interpretation from the ER physician when a full written interpretation is documented as a separate record in the medical record.
Expect duplicate-review submissions for the same date of service by two providers to be treated as duplicate services and denied.

Key Definitions

Preliminary read (wet read)

TermPreliminary read (wet read)

DefinitionA preliminary or 'wet' read is an initial interpretation of imaging performed in the emergency room.

Billing ruleER physician should not bill a preliminary/wet read separately because the initial read is included in the E&M service.

DocumentationIf an ER physician provides a full written interpretation, it must be documented as a separate record in the patient’s medical record to be billed separately.

Duplicate claim guidanceIf both the ER physician and a radiologist submit review/interpretation for the same date of service, it may be treated as a duplicate and denied.

Initial read / full written interpretation

TermInitial read / Full written interpretation

DefinitionInitial reads performed by the ER physician are considered part of the E&M service; a full written interpretation is a more comprehensive review documented separately.

Billing ruleAn ER physician may bill for an interpretation only when a full written interpretation is included and maintained as a separate record in the patient’s medical record.

Radiologist roleComprehensive detailed review and interpretation of imaging completed in the ER should, in most instances, be conducted and billed by a board-certified radiologist.

Duplicate submissionReview/interpretation submitted by two providers for the same date of service will be treated as duplicate service and may be denied.