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Reissued Multiple Radiology Reimbursement Policy

Release Date: November 21, 2012

Please note:  This article is revised from the original version and replaces any other versions released.  This medical policy was previously issued and later retracted pending an administrative hearing with the North Carolina Department of Insurance (NCDOI). The hearing process is now complete, and this policy is being reissued consistent with the hearing decision. You can view a copy of the NCDOI’s final decision granting summary judgment in favor of BCBSNC on our website or at www.ncdoi.com.

Blue Cross and Blue Shield of North Carolina (BCBSNC) has modified its reimbursement policies for multiple radiology procedures effective January 21, 2013.  The new reimbursement policy relates to the allowed amount for the technical component of certain outpatient (hospital or provider office) radiology procedures when performed in the same session.

The issuance of this policy is consistent with the final agency decision of the North Carolina Department of Insurance.  Although the decision gives BCBSNC the option to petition to do so, BCBSNC chooses not to implement these changes retroactively.  

BCBSNC is pleased that we now have clarity about this matter, and we can move forward with implementing this change to multiple radiology reimbursement.  You can view a copy of the NCDOI’s final decision granting summary judgment in favor of BCBSNC on our website or at www.ncdoi.com.

The BCBSNC Medical Policy has been reissued and is available at: http://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/radiology_services_reimbursement_policy_notification.pdf.

These changes are only applicable to BCBSNC commercial business, including the State Health Plan, and are not applicable for Blue Medicare® or the Federal Employee Program.

If you have any questions regarding this reissued policy, please contact the Provider Blue LineSM at 1.800.214.4844.