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Issue Number - Name
0147-Unbundling of MRI Procedures
Review Type
Automated
Claim Type
Professional Services, Outpatient Hospital
Region and State
RAC 1-4
All States
Date Approved
02/05/2019

Description

When a more extensive MRI is performed on the same site as a less extensive MRI, the less extensive MRI is bundled into the more extensive MRI

Affected Codes

70540, 70542-70553, 70557-70559, 71551-71552, 72141-72142, 72146-72149, 72156—72158,

72195-72197, 73218-73223, 73718-73723, 74181-71183, 75557, 75559, 75561 

Applicable Policy References

Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)-Exclusions from Coverage and Medicare as a Secondary Payer
Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1833(e)-Payment of Benefits
42 CFR, Section 405.980-Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)-Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)-Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
42 CFR, Section 405.986-Good Cause for Reopening 
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 3-Verifying Potential Errors and Taking Corrective Actions, Section 3.2.3.8-No Response or Insufficient Response to Additional Documentation Requests
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12-Physicians/Non-physician Practitioners, Sections 30(H)-Most Extensive Procedures and J-With/Without Procedures, Effective 10/1/03
CMS Pub. 100-04, Chapter 23, Section 20.9.2-Fee Schedule Administration and Coding Requirements
NCCI Policy Manual for Medicare Services, Chapter 1A
CPT Manual, 2015 to current