Effective Date:
Title: Section 447.2 - Radiology Services

447.2 Radiology Services.

(a) ACCOUNT NUMBER COST CENTER TITLE

7320 Radiology--Diagnostic

7360 Radiology--Therapeutic

7380 Nuclear Medicine

(b) The above cost centers use as the basis for the Standard Unit of Measure the Radiology Relative Values as determined by the California Medical Association, 1974 California Relative Value Studies (RVS). Relative Value Units for unlisted BR (By Report), and RNE (Relativity Not Established) procedures are to be reasonably estimated on the basis of other comparable procedures or estimated by qualified personnel. Use the "Total Unit Value", not the "PC Unit Value", in recording the relative value unit counts. Because the California Medical Association is no longer publishing their Relative Value Studies booklet, the Radiology/Nuclear Medicine chapter is set forth as subdivisions (c)-(g) of this section with the approval of CMA.

(c) RADIOLOGY AND NUCLEAR MEDlClNE GROUND RULES

(1) GENERAL: Listed values for radiology procedures apply only when these services are performed by or under the supervision of a physician.

(i) The total unit value includes the professional component (see PC unit value below) plus the technical component. The value for injection procedure is not included except when procedure is marked with a small star (*). (See ground rule 6, below). This value is applicable in any situation in which a single charge is made to include both professional services and the technical cost of providing that service.Identification of a procedure by its 5-digit code without modifier -26 or -27 indicates that the charge includes both the "professional" and "technical" components.

(ii) The PC unit value (professional component unit value) represents the value of the professional radiological services of the physician. This includes examination of the patient, when indicated, performance and/or supervision of the procedure, interpretation and written report of the examination and consultation with the referring physician. The value for injection procedure is not included except when procedure is marked with a small star (*). (See ground rule 6, below). This component is applicable in any situation in which the physician submits a charge for these professional services only. It does not include the cost of personnel, materials, space, equipment or other facilities. To identify a charge for professional component, use the 6-digit procedure code followed by modifier -26. (See modifier -26 and Appendix 1 for use of modifiers.)

(iii) When this section of the RVS is used in connection with a "conversion factor" to establish fees, it must be emphasized that the SAME conversion factor cannot be applied to both the TOTAL UNIT VALUE and the PROFESSIONAL COMPONENT UNIT VALUE. Physicians who determine their fees by application of conversion factors to the unit values in this section must determine a separate factor for TOTAL UNIT VALUE and for PC UNIT VALUE.

(iv) The technical component includes the charges for personnel, materials, including usual contrast media and drugs, film or xerograph, space, equipment and other facility but excludes the cost of radioisotopes. No unit values are listed for the technical component of radiology procedures, since these are institutional charges not billed separately by physicians. To identify a charge for the technical component, use thc 5-digit procedure code followed by modifier -27. (See modifier -27 and Appendix 1 for use of modifiers.)

(2) UNUSUAL SERVICE OR PROCEDURE: A service may necessitate skills and time of the physician over and above listed services and values. If substantiated "by report," additional values may be warranted. (See unit value modifier -22 and rule 4, below.)

(3) UNLISTED SERVICE OR PROCEDURE: When an unlisted service or procedure is provided, the values used should be substantiated "by report." (See rule 4 below.) Identify by unlisted procedure number in appropriate section. For a comprehensive listing, see pages 15-16.

(4) PROCEDURES LISTED WITHOUT SPECIFIC UNIT VALUES:

(i) BY REPORT "BR" ITEMS: BR in the value column indicates that the value of this service is to be determined "by report," because the service is too unusual or variable to be assigned a unit value. Pertinent information concerning the nature, extent and need for the procedure or service, the time, the skill and equipment necessary, etc., is to furnished. A detailed clinical record is not necessary.

(ii) RELATIVITY NOT ESTABLISHED "RNE"ITEMS: RNE in the value column indicates new or infrequently performed services for which sufficient data have not been collected to allow establishment of a relative value. A report may be necessary. (5) MATERIALS SUPPLIED BY PHYSICIAN: Identify as 99070. (Radionuclides are identified as 99069.) Supplies and materials provided by the physician (e.g., sterile trays, drugs, etc.) over and above those usually included with the office visit or other services rendered may be charged for separately. (List drugs, trays, materials or supplies provided.)

(6) INJECTION PROCEDURES: Values for Injection procedures include all usual pre- and post-injection care specifically related to the injection procedure, necessary local anesthesia, placement of needle or catheter, and injection of contrast media. Vascular injection procedures are listed in the cardiovascular section, under procedure codes 36000-36299. Other injection procedures are listed in appropriate sections. The injection procedure is included in the unit value for radiographic procedures marked with a small star (*).

(7) MISCELLANEOUS:

(i) A physician may elect to reduce the listed value of a service for a variety of reasons. To identify such charges, see modifier -52.

(ii) Examination outside of regular hours, at bedside or in operating room, may warrant an additional charge for technologist's time (see 99065, 99066).

(iii) Values for office, home and hospital visits, consultation and other medical services, anesthesia, surgical and laboratory procedures are listed in the sections entitled "Medicine," "Anesthesia," "Surgery" and "Pathology."

(8) SPECIAL SERVICES AND BILLING PROCEDURES:

(i) The following services are generally not part of the basic services as listed in the RVS, but do involve additional expense to the physician for materials, for his time or that of his employees. Those services that are generally provided as an adjunct to common medical services should be charged for only when circumstances clearly warrant an additional charge over and above the usual charges for the basic services.

Unit Value

(ii) 99065 Examination outside of regular hours may
warrant an additional charge for technologist's
time ........................................... 1.3(R)

(iii) 99066 Examination at bedside or in operating room,
unless otherwise indicated, may warrant an
additional charge for technologist's time ...... 1.3(R)

(iv) 99069 Radiopharmaceutical or other radionuclide
material cost. Listed values in this section do
not include these costs. List the name of
radiopharmiceutical, dosage and cost ........... BRt

(v) 99070 Supplies and material provided by the physician
(e.g., sterile trays, drugs, etc.), over and above
those usually included with the office visit or
other services rendered may be charged for
separately. List drugs, trays, supplies or
materials provided ............................. BRt

(vi) 99080 Special Reports (e.g., Insurance forms, narrative
reports, review of medical records): When
information more than that necessary to establish
or to clarify a patient's status is requested
(e.g., more than the standard reporting form) or a
request is made for review of medical records and
report, a charge adequate to cover the value of
the additional service is justifiable .......... BRt

(9) UNIT VALUE MODIFIERS.

(i) Listed values for most procedures may be modified under
certain circumstances as listed below. When applicable, the
modifying circumstances should be identified by the addition of
the appropriate "modifier code number" (including the hyphen)
after the usual procedure number. The values should be listed as
a single modified total for the procedure. When multiple
modifiers are applicable to a single procedure, see modifier
-99.

Unit Value

(ii) -22 Unusual services: When the services provided are
greater than those usually required for the listed
procedure, identify by adding this modifier (-22)
to the usual procedure number. List modified value.
May require report.

(iii) -28 Professional component: Under certain circumstances
the physician may wish to submit a charge for the
professional component of a procedure and not for
the technical component. (See definition of
professional component under Ground Rule 1). Under
these circumstances the professional component charge
is identified by adding this modifier (-28) to the
usual procedure number and valued according to the
"PC unit value" for that procedure.
(iv) -27 Technical component: Under certain circumstances, a
charge may be made for the technical component alone
(see definition of technical component under Ground
Rule 1). Under those circumstances the technical
component charge is identified by adding this
modifier (-27) to the usual procedure number.

(v) -52 Reduced values: Under certain circumstances, the
listed value is reduced or eliminated because of
ground rules, common practice, or at the physician's
election (e.g., a physician may elect to reduce the
listed values in a patient with multiple injuries
requiring extensive radiographic examination). Under
these or similar circumstances, the services provided
can be identified by their usual procedure numbers
and the use of a reduced value indicated by adding
this modifier (-52) to the procedure number. (Use
of this modifier provides a means of reporting
services at reduced charge without disturbing usual
relative values.)

(vi) -90 Reference (outside) laboratory: When laboratory
procedures are performed by other than the billing
physician, the procedure(s) shall be identified by
adding this modifier (-90) to the usual single or
panel procedure number and shall be billed as charged
to the physician. (For collection and handling
charges, see 99007 et seq.)

(vii)-99 Multiple modifiers: Under certain circumstances,
multiple modifiers may be applicable (e.g., a
physician may perform services greater than those
usually required (modifier -22)) and bill the
professional component (modifier -26)). Under
these circumstances, identify by adding this modifier
(-99) to the usual procedure number and briefly
indicate the circumstances. Value in accordance with
appropriate modifiers ............................... BRt

(d) DIAGNOSTIC RADIOLOGY. (1) Definitions.

(i) Limited examination: An examination which usually includes
AP and lateral views but is less than the "complete examination"
defined below. This may be due to limitation of routine views
by the physician; limitation for a specific purpose (e.g., AP
and lateral views on post-reduction fracture of ankle); or
necessary limitation due to the condition of the patient (e.g.,
single views for fractures in critically injured patient).

(ii) Complete examination: An examination which includes all of
the necessary views for optimal examination of the part for the
suspected condition. All listed values are for complete
examinations unless otherwise indicated. Necessary additional
methods cf examination (e.g., fluoroscopy, tomography,
cineradiography) may be charged for separately.

(2) Head and Neck.

70002 Pneumoencephalography.............. 25.0
(For injection procedure for
pneumoencephalography, see
61053, 62286)

70010 Cisternography, positive
contrast (posterior, fossa
myelography........................ RNE~
(For injection procedure, see
61052, 61053)

70020 Ventriculography, air or positive
contrast........................... 15.5
(For injection procedures for
ventriculography, see 61025,
61030, 61120)

70022 Stereotactic localization.......... BR**

*70024 Computer assisted tomography,
cerebral (e.g., EMI scan), with
or without intravenous contrast,
limited (2 or 3 scans)............. RNE~

*70025 complete (4 scans)................ RNE

*70028 each additional scan above 4....... RNE~

70030 Eye, for detection of foreign
body............................... 5.2

70040 for localization of foreign
body (70030 not included).......... 8.4

70050 combined 70030 and 70040........... 10.5

70100 Mandible, limited or
unilateral......................... 3.8

70110 complete........................... 5.9

70120 Mastoid(s), limited or
unilateral......................... 3.8

70130 complete and bilateral............. 7.6

70134 Internal auditory measures......... 7.1

*70136 Middle and Inner ear,
polytomography..................... RNE

70140 Facial bones, limited.............. 4.4

70150 complete, and/or orbits............ 6.4

70154 with nasal bones................... 7.3

70160 Nasal bones ....................... 3.9

70170 Nasolacrimal duct
(dacryocystography)................ 5.9
(For injection procedure for
dacryocystography, see 68850)
70190 Optic foramina .................... 3.8

70210 Paranasal sinuses limited.......... 3.1

70220 complete........................... 6.4

70240 Sella Turcica...................... 3.3

70250 Skull, limited .................... 3.8

70260 complete........................... 7.1

70300 Teeth, single view................. 1.3

70310 partial examination, less then
full mouth ........................ 2.5

70320 complete examination, full
mouth.............................. 4.7

70330 Temporomandibular joints........... 5.6

70350 Cephalogram (orthodontic).......... RNE

70360 Neck for soft tissues.............. 2.7

*70368 Soft palate, cineradiography or
videotape.......................... RNE

*70373 Laryngography, contrast............ 8.2
(For injection procedure for
laryngography, see 31708)

70380 Salivary gland for calculus........ 3.8

70390 Sialography........................ 5.1
(For injection procedure for
sialography, see 42550)

*70400 Orbitography, air or positive
contrast........................... BR**
(For injection procedure for
orbitography, see 67510)

*70999 Unlisted procedure, head and
neck............................... BR**

(3) Chest.

71000 Chest, "minifilm".................. 1.2

71010 Chest, single view................. 2.5

71020 two views.......................... 3.8

*71021 three views........................ 4.4

71030 complete, minimum of four
views.............................. 4.9

71034 including fluoroscopy.............. 6.4
(For independent chest
fluoroscopy, see 76000)

*71036 Fluoroscopic localization for
needle biopsy of intrathoracic
lesion, including follow-up
films.............................. BR**
(For biopsy procedure, see 32420)

*71038 Fluoroscopic localization for
bronchial brush biopsy or fiber
optic bronchoscopy, including
films.............................. BR**
(For biopsy procedure, see 31717)

71040 Bronchography, unilateral.......... 9.1

71060 bilateral.......................... 13.0
(For injection procedure for
bronchography, see 31710, 31715)

*71090 Fluoroscopy and radiography
for pacemaker insertion............ BR**
(For extended room time, see
76001)

*71100 Ribs, unilateral................... 4.4

71110 bilateral.......................... 5.4

71120 Sternum............................ 3.8

71130 Sternoclavicular joint(s).......... 3.8

*71199 Unlisted procedure, chest.......... BR**

(4) Spine and Pelvis.

72010 Spine, entire, survey study (AP
and lateral)....................... 9.3

*72020 Spine, any level, single view...... RNE

72040 cervical, AP and lateral........... 3.8

72050 complete........................... 6.0

72052 including flexion and extension
views.............................. 7.7

72070 thoracic........................... 4.4

72080 thoraco-lumbar junction ........... 4.4

72090 scoliosis study.................... 3.5

72190 lumbar, limited ................... 4.4

72110 lumbosacral, complete ............. 7.4

72114 including bending views............ 9.3

72120 bending views only................. 4.7

72170 Pelvis, limited.................... 3.1

72180 stereo............................. 3.8

72190 complete........................... 4.9
(For pelvimetry, see 74710)

72202 Sacro-iliac joints ................ 5.1

72220 Sacrum and coccyx ................. 4.1

72250 Myelography, lumbar or any
other single levels ............... 11.5

72270 all levels......................... 18.0

*72275 gas................................ BR**
(For injection procedures for
myelography, see 62284)

72290 Discography, lumbar or cervical.... 12.2
(For injection procedures for
discography, see 62290, 62291)

*72299 Unlisted procedures, spine or
pelvis............................. BR**

(5) Upper Extremities.

73000 Clavicle........................... 3.1

73010 Scapula............................ 3.8

73020 Shoulder, limited.................. 2.7

73030 complete........................... 3.8

73040 arthrography....................... 6.4
(For injection procedure for
arthrography, see 23350)
73050 Acromio-clavicular joints, bi
lateral, with or without weighted
distraction........................ 4.4

73060 Humerus, including one joint....... 3.1

73070 Elbow limited...................... 2.8

73080 complete........................... 3.8

*73085 arthrography....................... BR**
(For injection procedure, see
24220)

73090 Forearm, including one joint....... 3.0

73100 Wrist, limited..................... 2.5

73110 complete........................... 3.8

*73115 arthrography....................... BR**
(For injection procedure, see
25246)

73120 Hand, limited...................... 2.5

73130 complete .......................... 3.5

73140 Finger(s).......................... 2.3

*73499 Unlisted procedure, upper
extremities........................ BR**

(6) Lower Extremities.

73500 Hip, unilateral limited ........... 3.1

73510 complete (including AP pel
vis)............................... 4.4

*73515 bilateral, limited (e.g., infant
AP and frog lateral................ 3.9

73520 bilateral, complete (including
AP of pelvis)...................... 5.8

*73525 arthrography...................... RNE
(For injection procedures, see
27093-27094)

73530 during operative procedures
up to four studies................. 9.4

73532 each additional study.............. 1.8

73550 Femur (thigh), including one
joint.............................. 3.8

73560 Knee, limited...................... 2.7

73570 complete .......................... 4.0

73580 arthrography ...................... 9.1
(For injection procedure, see
27370)

73590 Tibia and fibula (leg), including
one joint ......................... 3.1

73600 Ankle, limited .................... 2.7

73610 complete .......................... 3.6

*73615 arthrography...................... RNE
(For injection procedures, see
27646)

73620 Foot, limited...................... 2.5

73630 complete........................... 3.4

73640 Foot and ankle..................... 5.9

73650 Os calcis (heel) .................. 2.7

73660 Toe(s)............................. 2.3

*73999 Unlisted procedure, lower
extremities........................ BR**

(7) Abdomen.

74000 Abdomen, single view (KUB)......... 2.6

74010 with additional oblique or
cone view.......................... 3.9

74020 complete, includes decubitus
and/or erect view.................. 5.1

(8) Gastrointestinal Tract.

74210 Pharynx and/or cerical esophagus... 5.4

74220 Esophagus.......................... 5.4

74230 Pharynx and/or esophagus,
by cineradiography................. 7.4

*74242 Upper gastronintestinal tract,
with or without KUB and with
or without delayed films........... 9.1

*74243 limited upper gastrointestinal
tract (e.g., recheck or follow
up study).......................... 6.4

74245 with small bowel, includes
multiple serial films, with or
without fluoroscopy................ 11.0

74250 Small bowel, includes
multiple serial films with or
without fluoroscopy or KUB,
independent study.................. 8.5

*74260 Duodenography, hypotonic........... RNE

74270 Colon, barium enema ............... 7.5

74275 combined with air contrast......... 11.0

74280 air contrast (independent
procedure)......................... 8.9

74290 Cholecystography, oral............. 6.0

74291 repeat examination, same
study.............................. 3.0

74300 Cholangiography operative.......... 7.6

*74305 post-operative (t-tube)............ *7.2
(For biliary duct stone



Volume: C