Code Bundling Rules for PET/MRI Services
Review how Horizon considers reimbursement of code combinations of eligible PET/MRI services when rendered on the same date of service.
This content was last reviewed on January 23, 2023 and may be subject to change. Please note that no updates have been made to the content so far for 2023.
Procedure code 73718 is bilateral eligible.
| Code | Code | Rule | Formula Used for Reimbursement |
|---|---|---|---|
| 78812 | 70540 73218 71550 74181 72195 73718 |
When the code from column A is billed with one or more codes from column B | 100% for the PET exam, 50% for the MRI with the highest RVU and 25% for any additional MRIs with lessor RVUs |