Local Coverage Article Billing and Coding

Billing and Coding: Chest X-Ray Policy

A57497

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Contractor Information

Article Information

General Information

Article ID
A57497
Article Title
Billing and Coding: Chest X-Ray Policy
Article Type
Billing and Coding
Original Effective Date
11/01/2019
Revision Effective Date
10/01/2021
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2021 American Dental Association. All rights reserved.

Copyright © 2013 - 2022, the American Hospital Association, Chicago, Illinois. Reproduced by CMS with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. You may also contact us at ub04@aha.org.

CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA), §1862(a)(1)(A), states that no Medicare payment shall be made for items or services which "are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."


Title XVIII of the Social Security Act, §1862(a)(7) and 42 Code of Federal Regulations (CFR) §411.15(a)(1), exclude routine physical examinations.

Title XVIII of the Social Security Act, §1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §80, Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests, sets forth the levels of physician supervision required for furnishing the technical component of diagnostic tests for a Medicare beneficiary who is not a hospital inpatient or outpatient.

CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §§80.4-80.4.4, Coverage of Portable X-Ray Services Not Under the Direct Supervision of a Physician applicability of health and safety standards apply to all suppliers of portable x-ray services and the scope of portable x-ray benefit and exclusions from coverage as portable x-ray services.

CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §250, Medical and Other Health Services Furnished to Inpatients of Hospitals and Skilled Nursing Facilities including payments under arrangement.

42 CFR 486.100, stipulates that portable X-rays must comply with Federal, State, and local laws and regulations.
  
CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, §3.4.1.3, Diagnoses Code Requirement.

42 Code of Federal Regulations, §410.32, addresses diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions.

CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, §§100 and 100.1, Interpretation of Diagnostic Tests describes how physicians should handle billing when two providers read a chest X-ray. Medicare will pay for the interpretation and report that directly contributes to the diagnosis and treatment of the individual patient.

CMS Manual System, Pub, 100-02, Medicare Benefit Policy Manual, Chapter 15, §80.6.1, Definitions.

Article Guidance

Article Text

The following coding and billing guidance is to be used with its associated Local coverage determination.

Coding Information

CPT/HCPCS Codes

Group 1

(4 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
71045 RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW
71046 RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS
71047 RADIOLOGIC EXAMINATION, CHEST; 3 VIEWS
71048 RADIOLOGIC EXAMINATION, CHEST; 4 OR MORE VIEWS

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
XX000 Not Applicable

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(20 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
D64.9 Anemia, unspecified
I70.90 Unspecified atherosclerosis
M06.9 Rheumatoid arthritis, unspecified
M25.559 Pain in unspecified hip
M54.50 Low back pain, unspecified
M54.51 Vertebrogenic low back pain
M54.59 Other low back pain
N39.0 Urinary tract infection, site not specified
R41.0 Disorientation, unspecified
R41.82 Altered mental status, unspecified
R51.0 Headache with orthostatic component, not elsewhere classified
R51.9 Headache, unspecified
R52 Pain, unspecified
R68.89 Other general symptoms and signs
S09.90XA Unspecified injury of head, initial encounter
T14.90XA Injury, unspecified, initial encounter
Z01.810 Encounter for preprocedural cardiovascular examination
Z01.818 Encounter for other preprocedural examination
Z04.3 Encounter for examination and observation following other accident
Z98.890 Other specified postprocedural states

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CodeDescription
999x Not Applicable

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2021 R2

Per the 2022 ICD-10 CM annual updates, code M54.5 was deleted, codes M54.50, M54.51, M54.59 were added to Group 1 of the ICD-10-CM Codes that DO NOT Support Medical Necessity section effective 10/1/2021.

10/01/2020 R1

10/1/2020-DX R51 was deleted from Group 1 under ICD-10 Codes that DO NOT Support Medical Necessity.

The following were Added to Group 1 under ICD-10 Codes that DO NOT Support Medical Necessity:

R51.0 - Headache with orthostatic component, not elsewhere classified

R51.9 - Headache, unspecified

Revision due to the Annual ICD-10 Updates, effective 10/1/2020.

Associated Documents

Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
09/22/2021 10/01/2021 - N/A Currently in Effect You are here
09/10/2020 10/01/2020 - 09/30/2021 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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