UnitedHealthcare adds new roadblock around radiology reimbursement
An impending policy change from UnitedHealthcare could cause providers to jump through additional hoops to receive reimbursement for some radiology services.
The insurer is set to “enhance” its Professional/Technical Component Policy, with the update taking effect April 1. This will result in requiring physicians to provide a full written interpretation and report in order to receive reimbursement for the professional component of certain radiology services that are billed in addition to evaluation and management (E/M) visits. This rule applies when these services are rendered to the same patient on the same day by the same provider.
If the provider submits a review of findings, rather than a full report, reimbursement for the professional component will be considered part of the E/M service. UHC has indicated this will occur regardless of whether the radiology service is billed globally or with modifier 26.
According to UHC’s summary of the policy, “the global radiology code’s professional component will not be considered for separate reimbursement unless a copy of the radiology report is attached to support separate reimbursement.”
Additionally, the report must align with the American College of Radiology’s guidelines. It should also be noted that the rule does not apply when the radiology and E/M service are billed by separate providers. However, in these cases, UHC recommends keeping documentation of the findings in the patient’s medical record.
To assist providers in submitting reports, UHC is implementing a Smart Edit that will walk users through the exact steps of providing the full interpretation report.
To learn more, click here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.