0136-Medical Necessity and Coding of Chest X-rays
Radiographs of the chest are common tests performed in many outpatient offices (radiology and many others), clinics, outpatient hospital departments, inpatient hospital episodes, skilled nursing facilities, homes, and other settings. They can be used for many pulmonary diseases, cardiac diseases, infections and inflammatory diseases, chest and upper abdominal trauma situations, malignant and metastatic diseases, allergic and drug related diseases. This review will ensure chest x-rays are paid when billed appropriately and only when medically necessary.
71045 – Radiologic Examination, chest-1 view
71046 – Radiologic Examination, chest-2 views
71047 – Radiologic Examination, chest-3 views
71048 – Radiologic Examination, chest-4 or more views
Applicable Policy References
42 CFR, 411.15(a)(1) – Particular services excluded from coverage; Routine physical checkups
42 CFR, 486.100 - Condition for coverage: Compliance with Federal, State, and local laws and regulations
Social Security Act, Section 1862(a)(1)(A), §1862(a)(7) – Exclusions from coverage
Social Security Act, Section 1833(e) – Payment of benefits
CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 80.4-80.4.4
CMS Pub, 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 80.6.1, Definitions.
L37547 (Noridian – JE) Chest X-Ray Policy, Effective Date For services performed on or after 06/22/2018
L37549 (Noridian – JF) Chest X-Ray Policy, Effective Date For services performed on or after 06/22/2018