Reimbursement Reduction for Similar Services During Same Session

Effective for dates of service on or after July 1, 2012, Medi-Cal will reduce its reimbursement for the professional component of Computed Tomography, Computed Tomographic Angiography, Magnetic Resonance Imaging and Magnetic Resonance Angiography procedures when more than one service of the same type of imaging is furnished by the same physician to the same patient, in the same session on the same day. Reimbursement for the professional component will be 100 percent for the service with the highest reimbursement price, and the reimbursement for the professional component of similar services provided during the same session will be reduced to 75 percent. Reimbursement for the technical component will be 100 percent for the service with the highest reimbursement price, and the reimbursement for the technical component of similar services provided during the same session will be reduced to 50 percent. Reimbursement reduction will occur for similar services only, for example, a CT scan followed by a CT scan. There will be no reduction when different types of imaging services are provided, such as a CT scan followed by an MRI scan. Reimbursement for multiple services during different sessions on the same day remains at 100 percent for each service. Source: General Medicine | June 2012 | Bulletin 456