State & FederalMedicaidJune 30, 2019

Reimbursement Policy Update: Multiple Radiology Payment Reduction (Policy 12-002)

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Category: Medicaid

There is a change regarding reimbursement for diagnostic imaging.

 

Currently, the global, professional component and technical component of diagnostic imaging procedures are reimbursed at 100% of the contracted/negotiated rate for each professional component and technical component service with the highest payment. Reimbursement of subsequent services is based on:

  • 95% of the professional component.
  • 60% of the technical component.


However, effective October 1, 2019, Empire BlueCross BlueShield HealthPlus will reimburse for diagnostic imaging procedures based on the following:

  • 100% of the fee schedule or contracted/negotiated rate for the highest valued procedure
  • 60% for the second and additional services

 

NYE-NU-0140-19

PUBLICATIONS: July 2019 Empire Provider News