Wiki Amerihealth and Independence BCBS denying ultrasound codes 76881,76882 & 76942

[Biller2023]

Hello!
Amerihealth NJ and Independence BCBS deny making payments for codes 76881,76882 & 76942 (ultrasound codes) stating

Services not provided by network/primary care providers. We are from a Sports Medicine specialty and our provider is certified to perform ultrasound services. We have explained all of this to Amerihealth NJ and Independence BCBS but they say only a radiologist can perform the above services. As per Amerihealth medical policy (links below), sports medicine provider can only use the codes listed below for Radiology. Could someone tell me what code we can use as a replacement to ultrasound codes (76881,76882 & 76942) for general body parts. Thank you! https://medpolicy.amerihealth.com/a...icy/dac0d3cb-ef26-44fb-9e86-d05b5a908853.aspx https://medpolicy.amerihealth.com/a...icy/79cbeb78-77b5-4b76-baac-1f3e7c80d896.aspx S.No Code Description 1 72010 radiological examination, spine, entire, survey study, anteroposterior (AP) and lateral, 2 72020 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 3 72040 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 4 72050 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 5 72052 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 6 72069 Typically a film is taken of the thoracolumbar spine from front to back (AP) while the patient is standing erect. 7 72070 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 8 72072 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 9 72074 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis. 10 72080 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 11 72081 72081-72084 describe radiologic examination of the entire spine, the codes differing based on the number of views 12 72082 72081-72084 describe radiologic examination of the entire spine, the codes differing based on the number of views 13 72083 72081-72084 describe radiologic examination of the entire spine, the codes differing based on the number of views 14 72084 72081-72084 describe radiologic examination of the entire spine, the codes differing based on the number of views 15 72090 radiologic examination, spine, scoliosis study, including supine and erect studies (replace with 72081-72084) 16 72100 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 17 72110 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 18 72114 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 19 72120 codes in the CPT code range 72020- 72120 describe radiologic examination of specific regions of the spine differing based on the region of the spine and the number of views 20 72170 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 21 72190 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis. 22 72200 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 23 72202 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 24 72220 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Spine and Pelvis 25 73000 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 26 73010 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 27 73020 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 28 73030 For example, if 3 views of the shoulder are obtained, CPT code 73030 (Radiologic examination, shoulder; complete, minimum of 2 views) with 1 unit of service shall be reported rather than CPT code 73020 (Radiologic examination, shoulder; 1 view) plus CPT code 73030. 3 29 73050 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 30 73060 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 31 73070 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 32 73080 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 33 73090 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 34 73092 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 35 73100 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities. 36 73110 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 37 73120 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 38 73130 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 39 73140 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Upper Extremities 40 73500 41 73501 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 42 73502 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 43 73503 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 44 73510 73510 Radiologic examination, hip, unilateral; complete, minimum of 2 views Deleted (73510 has been deleted. To report, see 73502, 73503) The 2016 code set deleted 73510 for a complete radiologic exam of a single hip 45 73520 46 73521 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 47 73522 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 48 73523 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 49 73540 Radiologic examination, pelvis and hips, infant or child, minimum of 2 views. 50 73550 51 73551 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 52 73552 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 53 73560 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 54 73562 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 55 73564 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 56 73565 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 57 73590 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 58 73592 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 59 73600 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 60 73610 radiologic examination, ankle; complete, minimum of three views) is used to bill for the X-ray. When billing for both the taking and the interpretation of CPT code 73610, do not use a modifier. 61 73620 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 62 73630 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 63 73650 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 64 73660 Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities 65 77071 Bone/Joint Studies

 

[sls314]

These are all X-ray codes. You cannot use these X-ray codes to rebill the ultrasounds, if that's what you're asking.

The payor's policy is pretty clear - the payor won't pay for ultrasounds done in your office. You could perform the limited list of x-rays in your office for these patients and be reimbursed.

Any other radiology services not listed under your specialty on C2, including ultrasounds, should be referred out to a radiology site contracted with AmeriHealth.

From the payor policy:

RADIOLOGY RULES AND LIMITED CIRCUMSTANCES

• Radiology services under the PPO benefit program (Radiology Network Rules and Limited Circumstances, Attachment C1) are considered eligible for payment in an outpatient and office setting when performed by a radiologist or pediatric radiologist at a contracted radiology site.
• The limited circumstances of radiology services that a participating specialist (this includes CRNPs and PAs practicing within these specialty groups), other than a radiology provider, may provide, and for which the provider may be eligible for reimbursement, are listed in Attachment C2. Refer to attachment C2 for the specific provider specialties and eligible codes.
• All other provider specialties are considered ineligible to provide radiology services, unless otherwise identified by specialty and code in attachment C2.