Alteration in 3D rendering payment methods reveals shifting perspectives among payers

In a recent development, the American College of Radiology (ACR) has voiced its concerns over a new bundled payment policy for 3D radiology services, issued by Blue Cross Blue Shield (BCBS) of North Carolina. The policy, which came into effect in February, has also been met with opposition from the Austrian Radiology Society (ÖRG).

According to BCBS of North Carolina, certain services such as 3D mammography services, Inter-Plan Program (IPP) Home, Medicare Advantage, and the Commercial and Federal Employee Program (FEP) were not impacted by the policy update. However, the ACR argues that the codes representing these services provide added clinical value and require additional time, dedicated resources, and specialized expertise.

The dispute centres around BCBS's decision that 3D rendering of imaging services (specifically CPT codes 76376 and 76377) are "integral to the primary service" and not separately reimbursable. The ACR contends that these services should be separately reimbursable due to their distinct nature and added clinical value.

The controversy arises from differences in payer attitudes toward advanced postprocessing imaging services. The ACR claims that these services are not inherently performed with every imaging study and that personal supervision by the radiologist during the performance of the procedure is required for code 76377.

In a letter to BCBS of North Carolina, ACR Payer Relations Committee Chair, Richard Heller, MD, stated that these codes represent distinct services that provide added clinical value. Heller also explained that the existence of specific CPT codes for 3D rendering affirms their status as standalone procedures, consistent with Centers for Medicare and Medicaid Services (CMS) policy and commercial payer precedents.

Readers are advised to refer to the August 21 ACR bulletin and Heller's letter for more information on this matter. The ACR's contention remains that 3D radiology services should be separately reimbursable due to their distinct nature and added clinical value.