CurrentPremera BluecrossPolicy N/A

Multiple Diagnostic Cardiovascular Services Reductions

Defines how Premera identifies diagnostic cardiovascular procedures subject to multiple-procedure technical component reductions and how technical and professional components are reimbursed when multiple such services are performed by the same provider on the same date of service.

Policy Summary

PayerPremera Bluecross

PolicyMultiple Diagnostic Cardiovascular Services Reductions

Policy CodePolicy N/A

Change TypeAnnual reviewno material changes

Effective DateSep 8, 2025

Next Review Date

Key ActionWhen procedures subject to the reduction occur in separate and distinct sessions on the same date, bill on separate claims with modifier XE and maintain documentation to avoid the 25% technical component reduction.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

25%TC reduction on subsequent procedures

MPFS Flag 6Identifying flag

Premera linesApplies to

CombineSame-session combine

XEModifier to avoid reduction

Multiple Diagnostic Cardiovascular Reduction Criteria

Covered when ALL of the following apply:

ALL of the following

Two or more diagnostic cardiovascular procedures that are identified by the CMS MPFS Multiple Procedure Flag 6 (subject to multiple diagnostic cardiovascular reductions) are performed on the same patient by the same physician or other qualified healthcare professional at the same session.
For the technical component (TC), the allowed amount of the second and each subsequent procedure will be reduced by 25%.25%
No reductions are applied to the professional component for these diagnostic cardiovascular procedures.

Policy Summary

PayerPremera Bluecross

PolicyMultiple Diagnostic Cardiovascular Services Reductions

Policy CodePolicy N/A

Change TypeAnnual reviewno material changes

Effective DateSep 8, 2025

Next Review Date

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.

For global codes subject to the reduction, separate the allowed amount into technical and professional components (by RVU percentages); reduce the technical component of the second and subsequent global codes by 25% and then recombine with the professional component to form the reduced global allowed amount.

If services subject to the reduction are billed on separate claims for the same session/date/provider, claims processing will combine them onto a single claim and apply the multiple diagnostic cardiovascular reductions to the technical component.

EXCEPTION - Separate and distinct sessions

When the same services are provided in multiple separate and distinct sessions/encounters on the same date (for example, AM and later PM), they must be billed on separate claims and submitted with modifier XE (Distinct Procedural Service) to indicate a separate encounter.
Documentation in the member's medical record must support the separate sessions/encounters; when XE is appropriately used and supported, multiple cardiovascular reduction should not apply.

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Codes and Payment Adjustment Details

Services subject to multiple diagnostic cardiovascular reductionmixedCovered

MPFS flag 6

Identifies diagnostic cardiovascular services subject to 25% TC reduction

Technical component reduction

Reduction amount25% reduction to the technical component of the second and subsequent diagnostic cardiovascular procedures

Applies toTechnical component (TC) only; professional component not reduced

Global code handlingFor global codes, separate allowed amount into TC and PC by RVU percentages; apply 25% reduction to TC of second and subsequent globals and recombine with PC

Claim Filing and Modifier Use

Billing Rule

Claim filing and modifier use for multiple diagnostic cardiovascular procedures

When diagnostic cardiovascular procedures subject to the multiple-diagnostic cardiovascular reduction are rendered to the same member, on the same date of service, by the same provider but billed on separate claims, the services billed will be combined onto a single claim during claims processing and the technical component of the applicable procedures will be subject to multiple diagnostic cardiovascular reductions. If the services are provided in multiple separate and distinct sessions/encounters on the same date (for example, morning and later the same day), bill on separate claims with modifier XE to identify the separate encounter; documentation in the member's medical record must reflect the separate sessions to support use of modifier XE and avoid the multiple cardiovascular reduction.

Combine separately billed same-session services onto a single claim; technical component reductions apply.
For truly separate and distinct sessions/encounters on the same date, bill on separate claims and append modifier XE to indicate a separate encounter.
Maintain documentation in the member's medical record/chart that supports multiple separate sessions to justify XE and prevent reduction.

Relevant Definitions and Modifiers

Multiple Procedure flag 6

CMS indicatorMultiple Procedure flag 6 — identifies diagnostic cardiovascular services subject to a 25% TC reduction

EffectSecond highest and subsequent procedures' technical components are reduced by 25% when multiple flagged services are performed in the same session by the same provider

ScopeApplies to diagnostic cardiovascular services as identified on the CMS National Physician Fee Schedule Relative Value Guide

XE (Separate Encounter)

Modifier purposeXE (Separate Encounter) — indicates services were provided during separate and distinct sessions/encounters on the same date to avoid multiple cardiovascular reduction

Billing requirementServices provided in separate distinct sessions must be billed on separate claims with modifier XE

DocumentationMember medical record/chart must document multiple separate sessions/encounters to support use of modifier XE