February 2, 2017
Our office still uses film for in-house x-rays. Is it true that we need to use a special modifier with x-ray claims in 2017? Will this new modifier impact payment?
Yes, for Medicare claims.
In the 2017 Medicare Final Rule, CMS directed providers to use modifier FX when reporting x-ray services that are performed using film rather than digital imaging technology. When x-ray claims are reported with modifier FX, the technical portion of the Medicare allowable will be reduced by 20%. The payment for the professional portion will not be reduced. To date this is a Medicare policy only, and modifier FX should not be required for commercial, managed care, or worker’s compensation claims.
Here’s a comparison for a 3 view radiologic examination of the knee, CPT 73562. As background, modifier TC is used to report only the technical portion of a radiology service, and modifier 26 is used to report only the professional interpretation portion. If the practice owns the radiology equipment and the billing physician performs the professional interpretation, the practice will typically report the CPT code as a single code “global” service, without the TC or 26 modifiers.
When modifier FX is appended to a globally-billed radiology claim the reimbursement for the technical portion will be reduced behind the scenes; it is not required that the practice “split” the claim and only apply FX to the technical portion.[table id=59 /]
*This response is based on the best information available as of 02/02/17.