Acceptable HCPCS codes for radiology and other diagnostic services are taken primarily from the Procedure code-4 portion of HCPCS. Payment is the lower of the charge or the Medicare physician fee schedule amount. Deductible and coinsurance apply, and coinsurance is based on the allowed amount.
For claims to A/B MACs (A) or (HHH), revenue codes, HCPCS code, line item dates of service, units, and applicable HCPCS modifiers are required. Charges must be reported by HCPCS code. If the same revenue code applies to two or more HCPCS codes, providers should repeat the revenue code and show the line item date of service, units, and charge for each HCPCS code on a separate line.
Payment Conditions for Radiology Services Professional Component (PC)
A/B MACs (B) must pay for the PC of radiology services furnished by a physician to an individual patient in all settings under the fee schedule for physician services regardless of the specialty of the physician who performs the service. For services furnished to hospital patients, A/B MACs (B) pay only if the services meet the conditions for fee schedule payment and are identifiable, direct, and discrete diagnostic or therapeutic services to an individual patient, such as an interpretation of diagnostic procedures and the PC of therapeutic procedures. The interpretation of a diagnostic procedure includes a written report.
