MO HealthNet has always required the units billed for a radiology service provided in the outpatient hospital setting to be the number of times a service or test was actually performed on that date of service for each participant, except when billing for facility charges. However, due to the payment methodology previously in place, the number of units billed did not affect the hospital’s payment for the service. This will no longer be the case for dates of service October 1, 2011 and after when outpatient hospital radiology services will be paid using a fee schedule. With the implementation of the fee schedule, hospitals will be reimbursed the lesser of either their usual and customary billed charge or the fee schedule amount for each radiology unit of service performed and billed.
For example, if radiology procedure 73090, Radiologic Examination Forearm Anteroposterior and Lateral, had to be performed on both arms for a patient in the emergency department, the units billed for that code will be two (2). Since the fee schedule has this code priced at $24.49 per unit, total payment will be $48.98. The submitted billed amount will be the hospital’s usual and customary amount for this procedure performed twice.
More information regarding the change to a fee schedule for outpatient hospital radiology procedures can be found in the provider bulletin titled
"Hospital – Outpatient Radiology: Vol. 34, No. 03”, dated September 22, 2011. Provider manuals can be found at
http://manuals.momed.com/manuals/.
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