CurrentMolina HealthcarePolicy N/A

Chest Radiography Reimbursement Policy

Defines Molina Healthcare's reimbursement stance for chest radiographs (CPT 71045, 71046, 71047, 71048) — when they are considered payable and documentation/diagnosis expectations; applies to Molina providers submitting claims. Includes state exception information where specified.

Policy Summary

PayerMolina Healthcare

PolicyChest Radiography Reimbursement Policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionInclude appropriate diagnosis codes reflecting relevant signs, symptoms, or disease on chest radiograph claims; incorrect diagnosis/procedure combinations may be reviewed, denied, and recovered.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4Not medically necessary codes

5Common settings listed

2023-09-08Created

multipleRevisions

Coverage Criteria for Chest Radiographs

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.

Coverage criteria for chest radiographs

Covered when ALL of the following are met:

ALL of the following

ALL of the following
- ANY of the following
  - ALL of the following
    Signs, symptoms, or disease of the chest (pulmonary, cardiac, infectious/inflammatory, traumatic, malignant/metastatic, allergic or drug-related) are identified and documented.
  - Clinical context requiring chest radiography (e.g., diagnosis or management of pulmonary or cardiac disease, chest/upper abdominal trauma) is documented.
ALL of the following
- Appropriate diagnosis codes reflecting the relevant signs, symptoms, or diseases are submitted with the radiology claim; diagnosis may be billed in any position on the claim.
ALL of the following
- ANY of the following
  - Preprocedural chest X‑rays performed in the absence of pulmonary or cardiac disease.
  - Chest X‑rays performed for screening in the absence of signs or symptoms.
  - Chest X‑rays ordered for minor, unrelated trauma (head, lower back, or extremities).
ALL of the following
- Molina Healthcare reserves the right to review, deny, and recover claims paid when diagnosis and procedure code combinations are submitted incorrectly.
- CMS lists CPT codes 71045, 71046, 71047, and 71048 as Group 1 codes that do not meet medical necessity for chest X‑ray services in certain contexts; these codes must be supported by appropriate findings per this policy.

Codes and Documentation Requirements

Chest X‑ray CPT codes (reference)CPT

71045	Chest radiograph; single view
71046	Chest radiograph; 2 views
71047	Chest radiograph; 3 views
71048	Chest radiograph; 4 or more views

Documentation requirement — diagnosis & claim expectations

Required diagnosis codingAppropriate diagnosis codes reflecting relevant signs, symptoms, or diseases must be submitted with chest radiograph claims; diagnosis can be billed in any position on the claim.

DX list exampleSpecific DX mappings shown in policy (examples include Z00.01, Z00.5, Z00.6, Z02.0, Z02.1, Z02.2, Z02.4, Z02.5, Z02.6, Z02.81, Z02.82, Z02.83, Z02.86, Z02.89, Z01.810, Z01.811, Z01.818).

Excluded practicesPreprocedural chest X‑rays without pulmonary or cardiac disease, chest X‑rays in the absence of signs or symptoms, and chest X‑rays for minor unrelated trauma are not accepted medical practices.

Claim review and recoveryMolina may review, deny, and recover claims if diagnosis/procedure code combinations are submitted incorrectly.

Authorization noteDo not include diagnoses from excluded approved authorizations; exclude approved authorizations as specified.

Provider Billing and Medical Necessity Actions

Denial Risk

Medical necessity and claim correctness

Providers must ensure medical necessity and claim correctness for chest radiology services. Molina Healthcare will reimburse radiology services for chest examinations only when relevant signs, symptoms, or diseases are documented and supported by appropriate diagnosis codes. If procedure and diagnosis code combinations are incorrect or do not support medical necessity, Molina Healthcare may review, deny, and recover any claims paid in error. Providers should verify coding prior to submission and correct or resubmit claims when notified to avoid denial or recoupment.

Ensure documentation supports medical necessity (signs, symptoms, or disease).
Include appropriate and specific diagnosis codes with chest radiology procedures.
Verify coding and claim combinations before submission to avoid denials or recoupment.
If notified of incorrect coding, correct and resubmit claims promptly.
Molina may review, deny, and recover payments for incorrectly coded claims.