CurrentPremera BluecrossPolicy cmi_154816

Multiple Diagnostic Imaging Reductions

Defines how the Plan identifies diagnostic imaging procedures subject to multiple procedure technical component reductions and how reductions are applied; affects providers submitting CMS-1500/837P claims across Premera Blue Cross and affiliated lines of business.

Policy Summary

PayerPremera Bluecross

PolicyMultiple Diagnostic Imaging Reductions

Policy CodePolicy cmi_154816

Change TypeRevisedRemovedClarified

Effective Date

Next Review Date

Key ActionWhen two or more subject imaging procedures are performed in the same session by the same provider, bill services on a single claim; failure to do so may result in denial of reimbursement.

SourceLink

POLICY UPDATE CHANGES

Revised the Multiple Procedures Rendered During the Same Session statement to remove combined claims process and advise these services should be billed on the same claim.

Removed statement that Blue Card Home/Host and FEP claims are not subject to this policy.

Clarified Purpose to indicate policy pertains to professional services billed on CMS-1500 or 837P forms and added link to CMS NPFS.

50%TC reduction

Flag 4NPFS indicator

03/12/26Last Approval

TC onlyComponent affected

Multiple Diagnostic Imaging Reduction Criteria

Multiple imaging reduction criteria

Application of multiple procedure reductions and billing requirements

ALL of the following

ALL of the following
- The procedure with the highest per-procedure allowance will be allowed at 100% of the procedure fee schedule allowance or the billed charge, whichever is less.
ALL of the following
- All other applicable lesser procedures performed in the same session will be allowed with a 50% reduction of the procedure fee schedule allowance for the technical component, or the billed charge, whichever is less.50%
ALL of the following

Policy Summary

PayerPremera Bluecross

PolicyMultiple Diagnostic Imaging Reductions

Policy CodePolicy cmi_154816

Change TypeRevisedRemovedClarified

Effective Date

Next Review Date

Key ActionWhen two or more subject imaging procedures are performed in the same session by the same provider, bill services on a single claim; failure to do so may result in denial of reimbursement.

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.

Billing, Modifier Use, and Claim Submission Requirements

Billing Rule

Bill separate claims and use modifier XE for distinct sessions

When multiple diagnostic imaging procedures subject to reductions are provided in multiple separate and distinct sessions/encounters on the same date by the same provider, bill the services on separate claims and append modifier XE (Separate Encounter) to identify the distinct sessions so multiple imaging reductions do not apply. Documentation in the member's medical record must support the multiple separate sessions/encounters.

Bill services provided in different sessions on separate claims.
Append modifier XE (Separate Encounter) to identify separate sessions and indicate multiple imaging reductions should not apply.
Ensure the member's medical record/chart documents the multiple separate sessions to support modifier XE use.

Denial Risk

Bill same-session imaging on a single claim to avoid denials

When two or more subject imaging procedures are performed in the same session by the same provider, the services must be billed on a single claim; failure to bill on the same claim may result in denial of reimbursement.

If procedures are in the same session, include them on a single claim so multiple diagnostic imaging reductions are applied appropriately.
Failure to bill on the same claim may lead to denial of reimbursement.

Terminology and Modifiers

Procedures identified on CMS NPFS as subject to 50% technical component reduction for second and subsequent procedures — Multiple Procedure flag 4

CMS NPFS indicatorMultiple Procedure flag 4 = Subject to 50% reduction of the technical component for second and subsequent procedures

Identification sourceCurrent Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS) Relative Value Guide

Effect on billingProcedures flagged with Multiple Procedure flag 4 are evaluated under the multiple imaging reduction rules when performed in the same session by the same provider

Modifier used to indicate services rendered in multiple separate and distinct sessions/encounters on the same date — Modifier XE - Separate Encounter

Modifier nameXE - Separate Encounter

PurposeIndicates services were rendered in multiple separate and distinct sessions/encounters on the same date to avoid multiple imaging reductions

Billing requirementServices provided in separate sessions on the same date should be billed on separate claims with modifier XE appended

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

XE	Separate Encounter
XS	Separate Structure
XP	Separate Practitioner
XU	Unusual Non-Overlapping Service
59	Distinct Procedural Service

OpenPayer

Multiple Diagnostic Imaging Reductions

Multiple Diagnostic Imaging Reduction Criteria

Coding and Reduction Details

Billing, Modifier Use, and Claim Submission Requirements

Terminology and Modifiers