Skip to main content
Shop Plans Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. Get Started Individual & Family Medicare Employer Vision Dental International Travel Find Care FAQ Blog Members Stay on top of your health care with helpful member resources. Members Home Medicare Health Dental Vision Find Care Member Knowledge Center Member Forms Medicare Forms Library Make a Payment Federal Employees Student Blue Healthy Blue Providers Access tools, policies and the latest information to help you care for our members. Providers Home Network Participation Networks & Programs Claims, Appeals & Inquiries Prior Authorization Services & CPT codes Prescription Drug Search Policies, Guidelines & Codes Provider News Provider FAQ Contact Us Employers Learn about our coverage options for small and large employers, and access tools and resources for your group. Employers Home Shop Employer Plans Employer Portal Support Member Forms & Resources Find Care Blog Agents Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Agents Home Agent Services Check Eligibility Support Find Care Member Forms & Resources Medicare Forms Library
Contact Us
Log In
I am ... Please select A member A provider An employer An agent
Log in to Agent Services Register for Agent Services
Log in to Employer Services Register for Employer Services I'm registered but need portal access
Username Forgot username? Continue to Log In Register for Blue Connect Need help? Learn how to log in.
Log in to Blue e Register for Blue e Log in to Dental Blue
Back
Lower Back Pain Imaging - Policy Update Effective June 18, 2023 April 25, 2023 Medical Policy & Clinical Guidelines

The Choosing Wisely® initiative evaluate usage of health care services with a goal of reducing excessive tests and procedures that result in unnecessary medical expense. Subject matter experts and specialty societies provide recommendations for preventing overuse of health care services having a potentially negative impact on both the quality and/or cost of health care.

Lower Back Pain (LBP) Imaging Policy Update Effective June 18, 2023: 

  • Imaging services (X-ray, CT scan, or MRI) billed within 28 days of a principal diagnosis of uncomplicated LBP are not eligible for reimbursement.
  • Imaging services may be appended with a KX modifier to indicate NCQA HEDISTM exclusionary criteria was met.
    • Examples of exclusionary criteria include, but are not limited to; members with a diagnosis of cancer, recent trauma, or uncomplicated lower back pain lasting more than 28 days

Please visit the related previous communication

View the Reimbursement Policy (PDF)

This communication applies to State Health Plan (SHP), Federal Employee Program (FEP), Administrative Services Only (ASO), Fully Insured, and Blue Card host claims. It does not apply to Blue Card home claims.