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There are a number of diagnostic x-ray procedures that have professional and technical components. Some insurers allow the professional and technical components to be billed separately. Blue Cross and Blue Shield of Alabama requires global billing for services rendered in an in-office setting for diagnostic services.
The expectation for Blue Cross Preferred Medical Doctors (PMDs) is that only a global bill be submitted for the procedure rendered. When an in-office diagnostic service (place of service 11) is performed, the PMD should submit for global reimbursement.
Example: A PMD takes an x-ray in his/her office, but sends the film to a radiologist to read. The PMD should still bill for the total fee.
The PMD may choose to bill for the professional component only. Blue Cross will reimburse when billed for the professional component. When submitting for the professional component, modifier 26 will need to be submitted in conjunction with the procedure billed. There is no reimbursement for the technical portion of the procedure if billed separately.When interpreting a radiological procedure rendered in an outpatient or inpatient facility setting, a physician may choose to bill for the professional component only.
Last Updated May 2015