R 418.10504 Multiple procedure policy for radiology procedures.

Rule 504. (1) A multiple procedure payment reduction shall apply to specified radiology procedures when performed in a freestanding radiology office, a non-hospital facility, or a physician's office or clinic. The primary procedure, identified by the code with the highest relative value, shall be paid at 100% of the maximum allowable payment. If the provider's charge is less than the maximum allowable payment, then the service shall be paid at 100% of the provider's charge. (2) The multiple procedure payment reduction shall apply when multiple radiological diagnostic imaging procedures are furnished to the same patient, on the same day, in the same session, by the same physician or group practice that has the same national provider identifier. The agency shall publish in a manual separate from these rules a table listing the diagnostic imaging CPT codes subject to the multiple procedure payment reduction. When more than 1 procedure from the table is furnished to the same patient, on the same day, in the same session, by the same physician or group practice, the procedure with the highest relative value is paid at 100% of the maximum allowable payment. Each additional procedure shall have modifier -51 appended and the technical component shall be reduced to 50% of the maximum allowable payment, or the provider's charge, whichever is less, and the professional component shall be reduced to 75% of the maximum allowable payment, or the provider’s charge, whichever is less.