Harvard Pilgrim is updating our commercial Radiology Payment Policy, effective for dates of service beginning Nov. 1, 2018.
Consistent with other policies, the Radiology policy will define “same” provider as a physician or other health care professional within the same billing group (reporting the same federal tax identification number [TIN]), unless the provider specialty or subspecialty is different. If multiple providers using the same TIN and of the same specialty provide radiology services to the same patient on the same date of service, Harvard Pilgrim will apply a multiple procedure payment reduction to the lower allowable radiological service (this includes bilateral services). This reduction will be 50% for global and technical (TC modifier) services, and 25% for professional (modifier 26) services.
For more information, please refer to Harvard Pilgrim’s updated Radiology Payment Policy. Additionally, a similar change was communicated in the the November 2017 issue of Network Matters regarding our commercial Evaluation & Management Payment Policy.