Description

Technical Component (TC) refers to the equipment and technician performing the test.

Modifiers exist to identify older radiology technology such as computed radiography, x-ray film and nonNational Electrical Manufacturers Association (NEMA) Standard XR-29-2013-compliant equipment. This policy reviews modifier reductions for these technology types used in radiology services.

Policy

Blue Cross Blue Shield North Carolina (Blue Cross NC) allows professional and facility reimbursement for the technical component of computed radiography, x-ray film and non-NEMA Standard XR-29-2013- compliant radiology services, according to the criteria outlined in this policy.

Reimbursement Guidelines

Modifier CT must be reported for computed tomography (CT) services that are furnished on non-NEMA Standard XR-29-2013-compliant CT equipment. Services billed with Modifier CT will receive 85% of the TC allowed reimbursement.

Modifier FX must be reported for radiology services using x-ray film. Services billed with Modifier FX will receive 80% of the TC allowed reimbursement.

Modifier FY must be reported for radiology services using computed radiography. Services billed with a Modifier FY will receive 90% of the TC allowed reimbursement.

For services billed with both Modifier FX and FY, the Modifier FX reduction will apply before the Modifier FY reduction.

Note: This policy applies to the TC-only and TC of the global charge. When applicable, multiple procedure and other pricing reductions will still apply.

Rationale

In alignment with CMS, Blue Cross NC will reduce reimbursement for services filed with Modifier CT, FX, or FY.

Billing and Coding

Related policy

Radiology Services Reimbursement Policy

Modifier Guidelines

References

CMS Radiology Services and Other Diagnostic Procedures

Claims Modifier Lookup

History

3/1/2024 New policy developed. RPOC approved. Notification on 3/1/2024 for effective date 5/1/2024 (tlc)

Application

These reimbursement requirements apply to all commercial, Administrative Services Only (ASO), and Blue Card Inter-Plan Program Host members (other Blue Cross and/or Blue Shield Plans members who seek care from the NC service area). This policy does not apply to Blue Cross NC Members who seek care in other states.

This policy relates only to the services and/or supplies described herein. Please refer to the applicable Member's Benefit Booklet for availability of benefits. Member's benefits may vary according to benefit design; therefore, member benefit language should be reviewed before applying the terms of this policy.