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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyHealthy Blue Louisiana Imaging Update | OpenPayer
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    CurrentHealthy Blue LouisianaPolicy G-12002

    Multiple Radiology Payment Reduction

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    This policy governs reimbursement for multiple diagnostic imaging procedures billed by professional and facility providers and establishes payment reductions based on CMS National Physician Fee Schedule multiple procedure indicators, provider or group, date of service, encounter, components, units, and applicable modifiers.

    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyMultiple Radiology Payment Reduction
    Policy CodePolicy G-12002
    Change TypeMaterial policy update
    Effective DateApr 1, 2026
    Last ReviewDec 10, 2024
    Next Review DateN/A
    Key ActionApply the multiple procedure payment reduction to multiple diagnostic imaging procedures with CMS NPFS multiple procedure indicator 4 when performed by the same provider or provider group on the same date during the same member encounter.
    SourceLink
    POLICY UPDATE CHANGES

    The policy added language specifying that diagnostic imaging procedures with a CMS National Physician Fee Schedule multiple procedure indicator of 4 are subject to a multiple procedure payment reduction.

    The policy removed the prior language stating that CT scan services are not subject to a multiple procedure payment reduction.

    100%Highest-allowance component reimbursement
    95%Subsequent professional component reimbursement

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    50%
    Subsequent technical component reimbursement
    MPI 4Multiple procedure indicator

    Multiple Diagnostic Imaging Reimbursement Rules

    Coding and Payment Indicators

    Distinct procedural service modifiersModifier
    59Distinct procedural service modifier indicating the procedure was performed on the same day but not during the same session
    XESeparate encounter modifier for distinct procedural services
    XPSeparate practitioner modifier for distinct procedural services
    XSSeparate structure modifier for distinct procedural services
    XUUnusual non-overlapping service modifier for distinct procedural services
    Required claim coding systemsmixed
    CPTCurrent Procedural Terminology codes used to report services and procedures
    HCPCSHealthcare Common Procedure Coding System codes used to report services and procedures
    Revenue codesRevenue codes used for applicable claim submissions
    Multiple Procedure Indicator
    Multiple procedure indicatorCMS National Physician Fee Schedule (NPFS) multiple procedure indicator (MPI) of 4
    Applies toMultiple diagnostic imaging procedures
    Payment effectProcedures with MPI 4 are subject to a multiple procedure payment reduction when the policy conditions are met
    Highest-Allowance Imaging Component
    Reimbursement rate100% of the contracted or negotiated rate
    Services includedEach professional component and technical component service with the highest allowance
    Procedure scopeThe global procedure, professional component, or technical component of diagnostic imaging procedures
    Subsequent Professional Component
    Reimbursement rate95% of the contracted or negotiated rate
    ComponentSubsequent professional component procedures
    Payment sequenceApplies to reimbursement of subsequent procedures after the service with the highest allowance
    Subsequent Technical Component
    Reimbursement rate50% of the contracted or negotiated rate
    ComponentSubsequent technical component procedures
    Payment sequenceApplies to reimbursement of subsequent procedures after the service with the highest allowance
    Multiple Units
    Multiple units ruleA single imaging procedure is subject to multiple imaging reductions when submitted with multiple units
    Procedure typeSingle imaging procedure
    Payment effectMultiple imaging reductions apply

    Billing and Documentation Actions

    Billing Rule

    Apply the MPI 4 multiple imaging reduction

    Apply the multiple procedure payment reduction (MPPR) to multiple diagnostic imaging procedures with a CMS National Physician Fee Schedule (NPFS) multiple procedure indicator (MPI) of 4 when the services are performed by the same care provider or care provider group on the same date of service during the same member encounter.

    • The highest-allowance professional and technical component services reimburse at 100% of the contracted or negotiated rate.
    • Subsequent professional components reimburse at 95%; subsequent technical components reimburse at 50%.
    • A single imaging procedure submitted with multiple units is subject to multiple imaging reductions.
    Billing Rule

    Use distinct procedural service modifiers when applicable

    When multiple imaging procedures are performed on the same day but not during the same session, report modifier 59 or the appropriate X{EPSU} modifier to indicate distinct procedural services and avoid the reduced allowance for the second and subsequent procedures.

    Policy Definitions

    General Reimbursement Policy Definitions
    Definitions sourceHealth plan's General Reimbursement Policy Definitions
    Policy contextMultiple Radiology Payment Reduction
    Health planHealthy Blue Louisiana
    Multiple Procedure Indicator (MPI) 4
    TermMultiple procedure indicator (MPI) 4
    DesignationA CMS National Physician Fee Schedule designation of 4
    MeaningIdentifies diagnostic imaging procedures subject to multiple procedure payment reduction under the conditions in this policy
    Policy Summary
    PayerHealthy Blue Louisiana
    PolicyMultiple Radiology Payment Reduction
    Policy CodePolicy G-12002
    Change TypeMaterial policy update
    Effective DateApr 1, 2026
    Last ReviewDec 10, 2024
    Next Review DateN/A
    Key ActionApply the multiple procedure payment reduction to multiple diagnostic imaging procedures with CMS NPFS multiple procedure indicator 4 when performed by the same provider or provider group on the same date during the same member encounter.
    SourceLink
    On This Page
    Multiple Diagnostic Imaging Reimbursement RulesCoding and Payment IndicatorsBilling and Documentation ActionsPolicy Definitions
    • Modifier 59: distinct procedural service.
    • XE: separate encounter.
    • XP: separate practitioner.
    • XS: separate structure.
    • XU: unusual non-overlapping service.
    Documentation Required

    Support billed imaging services

    Use proper, compliant billing codes for each imaging service and ensure the billed services are fully supported in the medical record or office notes. Services must also meet authorization and medical necessity requirements applicable to the procedure, diagnosis, and member’s state of residence.

    • Use CPT, HCPCS, and/or applicable revenue codes.
    • Failure to follow coding or billing guidelines may result in claim rejection or denial, payment recovery or recoupment, or reimbursement adjustment.
    Note

    Check controlling requirements

    Follow applicable provider, state, federal, and Centers for Medicare & Medicaid Services (CMS) contract or program requirements because they may supersede this reimbursement policy.

    • The policy applies unless controlling contracts or requirements indicate otherwise.
    • Check the most current applicable policy and requirements before submitting claims.
    Multiple Procedure Payment Reduction
    TermMultiple procedure payment reduction
    When it appliesTo the second and subsequent applicable diagnostic imaging procedures
    Required conditionsThe same care provider or care provider group performs multiple services on the same date of service during the same member encounter