Reimbursement Policy: Bundling Guidelines for Diagnostic Radiopharmaceuticals and Contrast Materials

Effective October 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will apply a revision to the reimbursement policy for Bundling Guidelines for diagnostic radiopharmaceuticals and contrast materials. This revision is consistent with CMS guidelines.

Diagnostic radiopharmaceuticals and contrast materials billed by a facility or in a facility place of service (POS) will not be eligible for separate reimbursement, as they are considered incidental to the related imaging procedure. This policy revision will not apply to professionals in a non-facility setting, such as in an office. Please see the related Commercial (PDF) and Medicare (PDF) policy for more information.

This change will apply to Commercial, Inter-Plan Program (IPP) Host, State Health Plan, Federal Employee Program (FEP) and Senior Market Administration (SMA). This will not apply to IPP Home.