Billing multiple radiology interpretations for the same service
Effective for dates of service on or after August 18, 2018, Priority Health will apply CMS guidelines to decide reimbursement for multiple radiology interpretation claims received for the same member for the same radiology service. We will process the first claim received. This applies to services to all Priority Health members regardless of plan.
As noted by CMS, services that directly contribute to the diagnosis and treatment will be processed for reimbursement.
For additional consideration of denied interpretations, providers will need to appeal the denial with documentation that supports diagnosing and treatment of the member.
For additional information, see CMS guidelines in the MLNMatters article SE1134.