Amends 405 IAC 5-27-1 to update definitions and terminology.

Amends 405 IAC 5-27-2 to clarify prior authorization and service limitations for radiologic procedures.

Amends 405 IAC 5-27-3 to update definitions and terminology and revise Medicaid policy for computerized tomography scans. Amends 405 IAC 5-27-6 to update terminology and revise Medicaid policy for sonography procedures.

Adds 405 IAC 5-27-7 to implement reimbursement and prior authorization policy for positron emission tomography scans.

INDUSTRY NEWS TAGS:Radiology

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Amends 405 IAC 5-27-1 to update definitions and terminology. Amends 405 IAC 5-27-2 to clarify prior authorization and service limitations for radiologic procedures. Amends 405 IAC 5-27-3 to update definitions and terminology and revise Medicaid policy for computerized tomography scans. Amends 405 IAC 5-27-6 to update terminology and revise Medicaid policy for sonography procedures. Adds 405 IAC 5-27-7 to implement reimbursement and prior authorization policy for positron emission tomography scans.

INDUSTRY NEWS TAGS:Radiology

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The Pennsylvania Patient Test Result Information Act requires that providers of diagnostic imaging services identify any “significant abnormality” in their results and directly notify the patient, or the patent’s designee, of the completed test, its review and its delivery to the ordering health care practitioner.

The Act was signed into law on October 24, 2018 and is scheduled to take effect on December 23, 2018.

INDUSTRY NEWS TAGS:Radiology

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Beginning with dates of service on or after Jan. 1, 2019, once prior authorization is requested for certain advanced outpatient imaging procedures (CT and MR) in accordance with its Outpatient Radiology Notification/Prior Authorization Protocol, UHC will review the site of care. UHC will not conduct site of care reviews if the procedure is planned to be performed in a outpatient freestanding imaging facility or an office setting.

INDUSTRY NEWS TAGS:Radiology

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New Hampshire Gov. Chris Sununu signed SB 189 into law on June 8, 2018, requiring private insurance coverage of 3D breast tomosynthesis imaging.

INDUSTRY NEWS TAGS:Radiology

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A previously published Medi-Cal Update added, changed and deleted CPT-4 codes for the 2018 annual update, effective February 1, 2018. Corrections to this policy are as follows:

CPT-4 codes 71045 – 71048, 74018, 74019 and 74021 do not require an approved Treatment Authorization Request (TAR) to be split-billed.

INDUSTRY NEWS TAGS:Radiology California Medi Cal Payor

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The recommendation in MedPAC’s June report to Congress has proposed reimbursement cuts to radiology of almost 4%, while increasing payments for services such as clinician and hospital outpatient visits by 10%.

INDUSTRY NEWS TAGS:Radiology Medicare

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The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain claims billed for CPT Codes 77385, 77386 and 77387. This issue caused some claims to erroneously pay and some claims to erroneously deny. The issue affected claims for dates of service from October 1, 2015, through December 3, 2016. No action is required on your part. Conduent will adjust erroneously paid claims and resubmit erroneously denied claims. Some claims will be voided and resubmitted as part of adjustment activity.

INDUSTRY NEWS TAGS:Radiology California Medi Cal

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A NewsFlash article published in December 2016 announced the removal of age restrictions for Every Woman Counts (EWC) breast cancer diagnosis codes effective for dates of service on or after January 1, 2017.

INDUSTRY NEWS TAGS:Radiology California Medi Cal

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Effective for dates of service on or after August 1, 2017, CPT code 75561 (cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences) was added as a Medi-Cal benefit. However the required modifiers, TC (technical only) and/or 26 (professional only), were mistakenly not included with the policy in the provider manual. This has been corrected.

INDUSTRY NEWS TAGS:Radiology California Medi Cal

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