CurrentFlorida BluePolicy 10-037

Multiple Imaging Reduction

Governs reimbursement when multiple radiological imaging procedures (CT, CTA, MRI, MRA, ultrasound) are reported for the same patient on the same date by the same provider, and affects providers billing Florida Blue.

Policy Summary

PayerFlorida Blue

PolicyMultiple Imaging Reduction

Policy CodePolicy 10-037

Change TypePC reduction added; clarifications

Effective DateMay 1, 2024 (coding edits applied)

Next Review Date

Key ActionWhen multiple imaging services on the same day are billed by the same provider, rank procedures by global RVU; pay primary at 100% and apply 50% TC and 5% PC reductions to secondary/subsequent procedures.

SourceLink

POLICY UPDATE CHANGES

A 5% reduction to the professional component (PC) of second and subsequent diagnostic imaging procedures was included.

Clarifying language added to the Reimbursement Information section and examples updated to reflect 2025 RVUs.

50%TC reduction for second and subsequent procedures

5%PC reduction for second and subsequent procedures

100%Primary procedure paid at

CT, CTA, MRI, MRA, USModalities subject

Multiple Imaging Reimbursement Rules

Coverage criteria and rules

Reimbursement approach when multiple imaging procedures are billed the same day by the same provider:

Primary imaging procedure = procedure with highest global RVU; primary procedure is eligible for 100% of the allowance.

ALL of the following

Technical component (TC) RVU reduced by 50%.
Professional component (PC) RVU reduced by 5%.
Add the reduced TC and PC RVU values to obtain a new RVU; divide the new RVU by the original total global RVU and multiply by 100 to determine the percent of the global value to apply; multiply the original fee-schedule global allowance by this percentage to determine the allowance for the secondary/subsequent procedure (rounded to the nearest thousandth).

Policy Summary

PayerFlorida Blue

PolicyMultiple Imaging Reduction

Policy CodePolicy 10-037

Change TypePC reduction added; clarifications

Effective DateMay 1, 2024 (coding edits applied)

Next Review Date

SourceLink

On This Page

Codes, Ranking, and Payment Reductions

Imaging codes subject to Multiple Imaging ReductionmixedCovered

See linked code list

CPT/HCPCS codes subject to Multiple Imaging Reduction; RVU and payment percentages are provided via Florida Blue link.

Ranking rule — Multiple imaging reduction (inv-03)

Primary procedure selectionPrimary imaging procedure = procedure with highest global RVU; paid at 100% of the allowance.

Secondary/subsequent reductionsTechnical component (TC) reduced by 50% and Professional component (PC) reduced by 5% for second and subsequent procedures.

Application to component-only billingIf TC-only submitted (modifier TC), TC reduced 50%; if PC-only submitted (modifier 26), PC reduced 5%.

Calculation overviewNew RVU = (reduced TC RVU + reduced PC RVU); percent = (new RVU / original global RVU) x 100; allowance = original global allowance x percent.

Exceptions, Appeals, and Billing Guidance

Documentation Required

Separate-session exception: document and appeal for review

If multiple imaging services on the same day occur in separate encounters for medically necessary reasons, Florida Blue may consider those studies as separate sessions. To have an exception considered, document the medically necessary reason in the patient’s medical record and submit an appeal for Florida Blue to review.

Documentation of the medically necessary reason must be present in the patient’s medical record.
Exceptions are considered by Florida Blue only upon appeal.

Definitions: PC, TC, and Global Service

Professional Component (PC) — definition (inv-05)

DefinitionProfessional Component (PC) = physician or other health care professional work portion (physician work/practice overhead/malpractice expense) of the procedure; supervision and interpretation that results in a written narrative report and directly contributes to diagnosis/treatment.

IdentifierWhen billed separately, PC is identified by modifier 26 or by reporting a standalone PC code.

ScopeRepresents the professional services portion of imaging separate from technical performance.

Technical Component (TC) — definition (inv-06)

DefinitionTechnical Component (TC) = performance (technician/equipment/facility) of the procedure.

IdentifierWhen billed separately, TC is identified by modifier TC or by reporting a standalone TC code.

ScopeRepresents the technical performance and resources required to perform the imaging, distinct from professional interpretation.

Global service — definition (inv-07)

DefinitionGlobal service = includes both professional and technical components; billing global asserts the same provider furnished supervision/interpretation and the technician/equipment/facility.

Billing implicationIf submitted as global, reductions for secondary/subsequent procedures are applied to the TC and PC based on global RVU ranking.

AssertionSubmission of a global service asserts that the same individual provided both professional and technical components for the procedure.