Commercial Radiology Payment Policy Update

Harvard Pilgrim is updating our commercial Radiology Payment Policy, effective for dates of service beginning Jan. 1, 2022, to expand the list of codes subject to the multiple imaging payment reduction in place today.

As a reminder, we currently apply a payment reduction when two or more of the payable procedure codes listed on the policy are rendered by the same provider (defined as the same physician, and/or other health care professional with the same specialty, within the same group, reporting the same Federal Tax Identification number) to the same patient, during the same session, on the same day. This multiple procedure payment reduction is applied to the lower allowable radiological service, including bilateral services. For services indicating the global (performance and interpretation) or technical (performance of the imaging service, indicated by modifier TC) component, a 50% reduction is applied; for the professional component (indicated by modifier 26), a 25% reduction is applied.

With the policy update, in addition to the codes already subject to a payment reduction, Harvard Pilgrim will apply a reduction to procedure codes C8900-C8920, C8931-C8936, and C9762-C9763.

Harvard Pilgrim and Tufts Health Plan have also concurrently reviewed Tufts Health Plan’s commercial Imaging Services Payment Policy and are making edits for consistency.

For more information, please refer to Harvard Pilgrim’s updated Radiology Payment Policy.


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