*Material Adverse Change (MAC)

 

For dates of service on and after April 1, 2022, Anthem Blue Cross and Blue Shield (Anthem) will apply multiple imaging reimbursement rules to the technical component of diagnostic imaging procedures. These rules apply across diagnostic imaging families, and modalities of radiology procedures and are not limited to contiguous body areas.

 

Multiple imaging reimbursement rules are applied to the maximum allowance for the Technical Component (TC) of the following diagnostic imaging procedures rendered on the same date of service and eligible for reimbursement:

  • Ultrasound, computed tomography (CT)
  • Computed tomographic angiography (CTA)
  • Magnetic resonance imaging (MRI)
  • Magnetic resonance angiography (MRA)

 

When two or more imaging procedures are performed in the same facility on the same patient on the same date of service, reimbursement is:

  • 100% of the highest facility allowance for the first imaging procedure for the date of service.
  • 50% of the facility allowance for each subsequent imaging procedure for that date of service.

 

Please review the policy in its entirety for more detailed information. For more information about this policy, visit the Reimbursement Policy page at anthem.com.

 

1502-0122-PN-KY.MO.WI



Featured In:
January 2022 Anthem Provider News - Wisconsin