June 2022

Billing Reminders and Multiple Procedure Reduction for Certain Diagnostic Imaging Procedures

This is a reminder for physicians and suppliers when billing for diagnostic imaging supplies and services for our PPO, Blue Choice PPO^SM and Blue High Performance Network^SM (BlueHPN^SM) members.

Technical Component (TC) Services – Modifier TC
Modifier TC applies to both TC-only services and the TC portion of global services on certain diagnostic imaging services.

Full payment is made for the service with the highest TC allowable.
Payment is made at 50 percent for the TC of subsequent services furnished by the same provider to the same patient in the same session on the same day.

Professional Component (PC) Services – Modifier 26
Modifier 26 applies to both PC-only services and the PC portion of global services.

Full payment is made for the service with the highest PC allowable.
Payment is made at 75 percent for subsequent PC services furnished by the same provider to the same patient in the same session on the same day.

Single vs Multiple Sessions
Blue Cross and Blue Shield of Illinois (BCBSIL) considers a single session to be one encounter where a patient could receive one or more radiological studies.

If more than one of the imaging services is provided to the patient during one encounter, this would constitute a single session and the lower priced procedure(s) would be reduced.
If a patient has a separate encounter on the same day for a medically necessary reason and receives a second imaging service, then BCBSIL considers these multiple studies on the same day to be provided in separate sessions.
In the latter case, BCBSIL has established that the physician should use modifier 59 to indicate multiple sessions and that the multiple procedure reduction doesn’t apply.

The information in this article is for illustrative purposes only. The actual process and coding of a patient’s medical condition will vary based on the individual circumstances and the information contained in the medical records.