American College of Radiology criticizes BCBS affiliate’s reimbursement policy change
The American College of Radiology is asking a Blue Cross Blue Shield affiliate to reverse what it says is a concerning new reimbursement policy change.
Effective Feb. 1, BCBS of North Carolina is no longer issuing separate payment for 3D rendering of imaging services (covered by CPT codes 76376 and 76377). This post-processing technique involves turning a series of 2D, cross-sectional CT or MR images into a navigable 3D model.
BCBS in its coverage update said it sees 3D rendering as “integral to the primary service” and thus it will “not be separately reimbursable.” However, ACR said it “strongly disagrees” with this new rule and is urging for its revocation so the insurer is in alignment with Medicare and other payers’ reimbursement policies.
“These codes represent distinct services that provide added clinical value, require additional time as well as dedicated resources and specialized expertise, [and] are not inherently performed with every imaging study,” Richard E. Heller III, MD, MBA, chairman of the ACR Payer Relations Committee, wrote in a recent letter to BCBS of North Carolina’s CEO, adding that, in the case of code 76377, a radiologist’s supervision is required during performance of the procedure. “The use of these codes is driven by medical necessity and is only applied when warranted by the clinical scenario, which underscores their separability.”
Heller—who also is senior VP of health policy at Radiology Partners—emphasized the existence of separate CPT codes for 3D rendering. This “further affirms their status as standalone procedures.” He noted that 3D rendering is not automatically nor routinely performed as part of standard imaging interpretation. Plus, this work consumes additional resources beyond what is accounted for in the primary CPT code. Typically, the creation of renderings involves dedicated work by trained personnel, specialized software and extra doc input.
“The manipulation, review, analysis, and reporting of 3D renderings involves significant additional physician work beyond base imaging codes,” Heller wrote. “This often includes image segmentation, adjustment of the projection and shading of the 3D renderings to optimize visualization of anatomy or pathology, comparison to the base 2D images and to all pertinent available prior studies, and discussion of surgical implications with referring physicians.”
ACR highlighted its concerns in a news item published on Thursday. In its original policy update, BCBS of North Carolina said the change applies to both professional and facility services. However, 3D mammography will not be impacted by the change. It applies to commercial plans and the Federal Employee Program but not its Inter-Plan Program Home nor Medicare Advantage offerings.
“Blue Cross NC is implementing this change to ensure consistent reimbursement practices. This aligns with Blue Cross NC’s mission to make healthcare more affordable for all,” the insurer, which covers approximately 4.3 million members, said in November.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.