Policy Statement
The Centers for Medicare & Medicaid Services (CMS) established a reimbursement methodology for certain multiple diagnostic imaging services performed on the same patient, on the same day, during the same imaging session, by the same physician/QHP or physician/group practice. The reimbursement methodology is separated into three groups based on the three diagnostic imaging families which are
- Diagnostic Imaging Services
- Diagnostic Cardiovascular Imaging Services
- Diagnostic Ophthalmology Imaging Services
The multiple reduction reimbursement methodology applies independently to the specific diagnostic imaging families when multiple imaging services within the same family are performed for the same patient during the same imaging session on the same date of service by the same physician/QHP or physician/Group practice.
The technical component of radiology services furnished to hospital patients is included in the hospital claim and should not be billed on a professional claim.
Modifier 59
When multiple diagnostic imaging services within the same diagnostic imaging family are performed on the same day for the same patient, but at different imaging sessions, modifier 59 must be reported for the subsequent session(s) to allow separate reimbursement. Modifier 59 should not be appended when all imaging services are rendered during the same imaging session.
Multiple Diagnostic Imaging Reduction (MDIR) Methodology
Diagnostic services subject to the MDIR methodology can be identified in the CMS National Physician Fee Schedule Relative Value Unit (NPFSRVU) File under the column MULT PROC with indicator “4”. This MDIR applies to both professional and technical services when these diagnostic imaging services are performed for the same patient during the same imaging session on the same date of service by the same physician/QHP or physician/Group practice. This includes all outpatient institutional radiology claims and ambulatory surgical center (ASC) claims billed on the UB-04 Claim Form as well as physician, QHP, or allied provider claims billed on the CMS-1500 Claim Form.
