Healthcare Administrative Partners (HAP) continually monitors issues that affect your practice’s reimbursement.
Here is a compilation of our latest items:
CTA Head/Neck Billing
The new bundled CPT code for CTA Head/Neck studies (70471) that became covered by Medicare for 2026 is still receiving mixed payments from commercial payers and denials from Medicaid. The new code is being added to many states’ Medicaid fee schedules beginning in July, but we see no trend among commercial payers. Foregoing the new code and billing the two separate codes 70496 (CTA head) and 70498 (CTA neck) could be a compliance risk, so there is no good answer at the moment. We recommend diligence in monitoring the results for these claims, including appeal and re-submission of denied claims.
Anticipated 2027 Coding Changes
The American College of Radiology has released its document summarizing the anticipated CPT code changes for 2027. Most significant will be the bundling of MRA Head/Neck procedures, similar to this year’s bundling of those procedures under CT. Codes 70544 – 70549 will be revised to include post-processing, and 3 new codes will be available for MRA of the head and neck without and/or with contrast. New codes will also become available for Intraosseous Fiducial Marker Placement, and the Prostate Biopsy Service codes will be revised.
Category III Codes Available in July
Along with the Category I code changes that take place next January, the ACR has made us aware of new Category III codes that are effective July 1, 2026. These codes have not been approved for payment by Medicare, and it is unlikely that commercial payers will recognize them, but their use helps demonstrate their value and therefore they could become payable in the future. The new codes include:
- Ultrasonic Propulsion Clearance of Urinary Calculi
- Quantitative Transmission Volumetric Ultrasound Tomography of the Breast
- Quantitative Magnetic Resonance Analysis of Hepatic Steatosis
- Pancreatic Histotripsy
- Digital 3D Modeling
- Items and services furnished to a single patient on the same or consecutive dates of service and billed on the same claim form;
- Items and services furnished to one or more patients and are billed under the same or a comparable code; or
- Radiology, anesthesiology, pathology, and lab items and services that are furnished to one or more patients under service codes belonging to the same Category 1 CPT code section.
New ICD-10 Code for Ultrasound AAA Screening
CMS Transmittal 13694 adds new ICD-10 code Z13.6, Encounter for screening for cardiovascular disorders, as a covered diagnosis for Abdominal Aortic Aneurysm (AAA) screening (76706). The new code is to be used in combination with either Z87.891, F17.210, F17.211, F17.213, F17.218, F17.219, or Z84.89.
No Surprises Act (NSA) Independent Dispute Resolution (IDR) Rules Change
The NSA Final Rule issued in May makes some adjustments to the IDR process that are generally viewed as favorable to radiologists. Most notably is the reduction of the filing fees from $115 down to $15 per party per dispute case. Cases may now be batched based on:
The Final Rule limits batched determinations to 50 qualified IDR items in a single dispute. There are also positive changes in the communication, negotiation, and eligibility rules. The American College of Radiology (ACR) provided a summary of the NSA Final Rule that gives many more details.
Appropriate Use Criteria (AUC) for Clinical Decision Making (CDS)
In our recent Legislative Update we mentioned the Radiology Outpatient Ordering Transmission (ROOT) Act that is making its way through Congress. This bill, if passed, would resurrect the requirement for ordering physicians to consult Appropriate Use Criteria (AUC). In addition to the ACR, the Society of Interventional Radiology (SIR) is now in full support of the bill, citing a potential for reduction of wasteful and unnecessary imaging that could help save Medicare up to $700 million annually.
The ACR has long promoted the value of AUC, and recently it added 8 new topics to its Appropriateness Criteria and revised 8 other topics.
Prior Authorization for Certain IR Services
Medicare is delaying implementation of prior authorization for percutaneous image-guided lumbar decompression for spinal stenosis under the Wasteful and Inappropriate Service Reduction (or “WISeR”) model that was rolled out across New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington in traditional Medicare on January 1, 2026. The IR procedure had been identified as an image-guided procedure that was prone to abuse, along with the neurosurgical procedure of deep brain stimulation for essential tremor and Parkinson’s. The delay came as a result of push-back from radiologists and other medical specialties.
Anthem Out of Network Policy
On June 1st Anthem began charging hospitals a 10% administrative penalty of the allowed amount for hospital claims involving radiologists and other physicians outside of the insurer’s networks. According to Radiology Business, “The insurer first announced the new out-of-network penalty last October, drawing widespread criticism from radiologists and others in the industry. It initially targeted 11 states including Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio and Wisconsin. Indiana passed legislation this year stopping Anthem from implementing the policy there, while the insurer also subsequently expanded it into New York in April.” California hospitals are now suing Anthem over the policy.
Noridian Pre-payment Review Policy
Medicare contractor Noridian has implemented a targeted review policy that is delaying payment of claims for certain CT and MRI procedures. CT Abdomen and Pelvis with Contrast (74177) and MRI Spine without contrast (72148) are not submitted with sufficient documentation to support payment, according to Noridian. As part of the review, Noridian is requesting medical records that are not in control of the radiologists. Accordingly, the RBMA and ACR have requested that the professional component of those services be exempted from the payment delay or denial, a request that was denied by Noridian. It appears that the technical component claims are being paid without review, according to the two organizations.
Expansion of Non-Physician Providers’ Scope of Practice
A bill pending in Ohio would allow nurse practitioners and physician assistants to supervise x-ray machine operations. The ACR has opposed the legislation citing safety risks due to lack of specific radiologic training.
Next Update
Watch for our next quarterly update at the end of September and be sure to subscribe to this blog to stay abreast of the many changes that affect your radiology practice.
Related Articles
Legislation & Regulations That Could Affect Radiology Practices
Expanding Opportunities for Interventional Radiology Practice
What's HaPpening in Radiology - Q1 2026
Copyright © 2026 Healthcare Administrative Partners. All Rights Reserved.
Leave a Reply