CurrentPremera BluecrossPolicy N/A

Multiple Diagnostic Cardiovascular Services Reductions

Defines identification and application of technical-component reductions (25%) for multiple diagnostic cardiovascular procedures subject to CMS Multiple Procedure flag 6; applies to Premera lines of business listed.

Policy Summary

PayerPremera Bluecross

PolicyMultiple Diagnostic Cardiovascular Services Reductions

Policy CodePolicy N/A

Change TypeClarification & administrative removal

Effective DateSep 8, 2025

Next Review Date

Key ActionBill separate and distinct same-day sessions with modifier XE and retain documentation to avoid technical-component multiple procedure reductions.

SourceLink

POLICY UPDATE CHANGES

Clarified the Purpose statement to indicate that the policy pertains to Professional services billed on a CMS-1500 or 837P electronic claim forms.

Removed the statement that Blue Card Home/Host and Federal Employee Program (FEP) claims are not subject to this policy.

25%reduction applied to TC of 2nd and subsequent diagnostic cardiovascular procedures

Flag 6CMS indicator for services subject to reduction

Multiple LOBsplan scope

Claims combinedprocessing rule

Reduction Rules for Multiple Diagnostic Cardiovascular Procedures

Multiple diagnostic cardiovascular reduction rules

When two or more diagnostic cardiovascular procedures subject to CMS multiple procedure flag 6 are performed the same session by the same provider:

Identify procedures subject to reduction using CMS Multiple Procedure flag 6.

For the technical component, reduce the allowed amount of the second and each subsequent applicable procedure by 25%.

Do not apply reductions to the professional component.

For global services, separate the code into technical (TC) and professional (PC) components based on RVU percentages; reduce the TC of the second and subsequent global codes by 25%, then recombine with the PC to form the reduced global allowed amount.

Policy Summary

PayerPremera Bluecross

PolicyMultiple Diagnostic Cardiovascular Services Reductions

Policy CodePolicy N/A

Change TypeClarification & administrative removal

Effective DateSep 8, 2025

Next Review Date

Key ActionBill separate and distinct same-day sessions with modifier XE and retain documentation to avoid technical-component multiple procedure reductions.

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.

Relevant Codes and Reduction Details

CMS multiple procedure flagmixed

Multiple Procedure flag 6

CMS indicator: subject to 25% reduction of the second highest and subsequent procedures to the TC of diagnostic cardiovascular services

Technical component reduction — 25% for second and subsequent procedures (CMS flag 6)

Reduction amount25% reduction to the Technical Component (TC) of the second and each subsequent diagnostic cardiovascular procedure subject to CMS Multiple Procedure flag 6

ScopeApplies when two or more diagnostic cardiovascular procedures subject to CMS Multiple Procedure flag 6 are performed on the same patient by the same physician or other qualified health care professional at the same session

ApplicationReduction is applied to the allowed amount of the TC for the second and each subsequent procedure

Global services handlingFor global codes, separate into TC and PC using RVU percentages, reduce the TC of subsequent codes by 25%, then recombine with the PC to form the reduced global allowed amount

Billing Guidance and Avoiding Reductions

Billing Rule

Modifier XE use to avoid reduction

When diagnostic cardiovascular procedures that are subject to multiple diagnostic cardiovascular reductions are rendered to the same member on the same date of service by the same provider but at separate and distinct sessions/encounters (for example, services rendered in the morning and again later the same day), bill each session on a separate claim and append modifier XE (Separate Encounter) to identify the services as separate and distinct. Use of modifier XE prevents application of the multiple diagnostic cardiovascular reduction to those separately rendered sessions. The member's medical record must document the separate and distinct sessions/encounters to support use of modifier XE.

Modifier: XE — Separate Encounter
Requirement: Documentation in the medical record must reflect separate and distinct sessions/encounters on the same date of service
Effect: Prevents multiple diagnostic cardiovascular reductions for technical components when correctly applied

Billing Rule

Combining separate claims for same session

If multiple diagnostic cardiovascular procedures that are subject to the multiple diagnostic cardiovascular reduction are rendered to a member during the same single session/encounter on the same date of service by the same provider but billed on separate claims, the claims will be combined for claims processing and the combined services will be subject to the multiple diagnostic cardiovascular reductions for the technical component of the applicable procedures. Providers must ensure procedures from the same session are billed on the same claim to avoid automatic combination and reduction.

Same session, different claims: services will be combined for processing and reductions applied
Same provider, same date, same session: bill on one claim

Component Definitions

Technical Component (TC) — definition

DefinitionTechnical Component (TC): the portion of a diagnostic cardiovascular service that covers equipment, supplies, and technical services required to perform the procedure

Policy applicationReductions under this policy apply only to the TC when multiple applicable diagnostic cardiovascular procedures are performed in the same session

Global code processingFor global submissions, the code’s allowed amount is separated into TC and PC using RVU percentages before applying TC reductions

Professional Component (PC) — definition and non-reduction note

DefinitionProfessional Component (PC): the portion of a diagnostic cardiovascular service representing physician work and professional interpretation

Reduction statusNo reductions will be applied to the PC for diagnostic cardiovascular procedures subject to the multiple cardiovascular reduction concepts

Global services handlingWhen global codes are separated into TC and PC, only the TC portion is reduced; the PC portion remains unchanged and is recombined after TC reduction