CurrentHumanaPolicy CP2017010

Modifier FX (film X-ray reimbursement)

This policy governs Humana Medicare Advantage payment processing for X-ray services reported with modifier FX (film X-rays), specifying coding expectations and a 20% reimbursement reduction to the technical component for such services. It applies to providers billing Humana Medicare Advantage products.

Policy Summary

PayerHumana

PolicyModifier FX (film X-ray reimbursement)

Policy CodePolicy CP2017010

Change TypeNo material change

Effective DateJan 1, 2017

Next Review Date

Key ActionProviders must append modifier FX to a procedure code for an X-ray service furnished using film; requirement applies to TC-only and global charges.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

20%TC reimbursement reduction

2017-01-01Effective date

Medicare AdvantageProduct

FXRequired modifier

Film X-ray (Modifier FX) Payment and Billing Criteria

Film X-ray (Modifier FX) payment and billing criteria

Payment adjustment and coding requirement for film X-rays:

Providers must append modifier FX to procedure codes for X-ray services furnished using film (requirement applies to TC-only charges and to global charges).

Humana reduces reimbursement for the technical component (TC) of film X-ray services reported with modifier FX by 20% for dates of service beginning January 1, 2017 (reduction applies to the TC of a TC-only charge and to the TC of a global charge).

Claims remain subject to other plan requirements, including medical necessity, reasonableness, and applicable referral or authorization requirements.

Policy aligns with CMS direction and the Consolidated Appropriations Act of 2016 to incentivize transition from film to digital radiography to reduce radiation exposure.

Modifier and Reimbursement Coding

Policy Summary

PayerHumana

PolicyModifier FX (film X-ray reimbursement)

Policy CodePolicy CP2017010

Change TypeNo material change

Effective DateJan 1, 2017

Next Review Date

Key ActionProviders must append modifier FX to a procedure code for an X-ray service furnished using film; requirement applies to TC-only and global charges.

SourceLink

On This Page

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Modifier FXModifierCovered

FX	Modifier FX — X-ray taken using film; append to procedure code for film X-ray services (applies to TC-only and global charges)

TC reimbursement reduction — 20% reduction to the technical component for film X-ray services reported with modifier FX (effective 2017-01-01)

Reimbursement reductionHumana reduces reimbursement for the technical component (TC) of film X-ray services reported with modifier FX by 20%.

Effective dateApplies to dates of service beginning January 1, 2017.

Scope of reductionReduction applies to the TC of a TC-only charge and to the TC portion of a global charge for the service.

Regulatory basisOriginal Medicare reimbursement reduction for film X-ray TC was required by the Consolidated Appropriations Act of 2016 and CMS directed use of modifier FX.

Key Definitions

Global charge

DefinitionA global charge is a single charge for both the technical component and the professional component of a service.

Components includedEncompasses both the facility/equipment/non-physician (TC) costs and the professional (physician interpretation) component.

Applies toUsed when billing a combined fee rather than separate TC and professional component charges.

Modifier FX

DefinitionModifier FX indicates an X-ray taken using film.

Billing requirementProviders must append modifier FX to a procedure code for an X-ray service furnished using film (applies to TC-only and global charges).

PurposeIdentifies film-based X-ray services for payment processing and any applicable adjustments.

Technical component (TC)

DefinitionThe technical component (TC) of a service is for all non-physician work and includes administrative, personnel and capital (equipment and facility) costs and related malpractice expenses.

IncludesNon-physician labor, facility and equipment costs, administrative support, and related malpractice expense.

Billing contextTC may be billed separately (TC-only) or as part of a global charge; payment adjustments (e.g., FX-related reduction) apply to the TC portion.

OpenPayer

Modifier FX (film X-ray reimbursement)

Film X-ray (Modifier FX) Payment and Billing Criteria

Modifier and Reimbursement Coding

Billing and Documentation Requirements for Providers

Key Definitions