Code Bundling Rules for Radiology, Cardiology and Ultrasound Services

The table below identifies how Horizon considers reimbursement of combinations of eligible radiology, cardiology or ultrasound services rendered on the same date of service. This content was last revised on January 3, 2022 and may be subject to change.

Column A Codes	Column B Codes	Rule	Formula Used for Reimbursement
70486 70487 70488	70450 70460 70470	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
70490 70491 70492	70450 70460 70470	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
70490 70491 70492	70486 70487 70488	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
70490 70491 70492	71250 71260 71270	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
70490 70486 70450		When all three are billed together	100% of the highest RVU , 50% of the second and 25% of the third
70491 70487 70460		When all three are billed together	100% of the procedure with the highest RVU , 50% of the second and 25% of the third
70492 70488 70470		When all three are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
74176 74177 74178	71250 71260 71270	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
74176 74177 74178	70490 70491 70492	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
74176 74177 74178	71250 70490	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
	71260 70490
	71270 70490
74176 74177 74178	71250 70491	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
	71260 70491
	71270 70491
74176 74177 74178	71250 70492	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
	71260 70492
	71270 70492
70490 70491 70492	71250 72192	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
	71260 72192
	71270 72192
70490 70491 70492	71250 72193	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
	71260 72193
	71270 72193
70490 70491 70492	71250 72194	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
	71260 72194
	71270 72194
70490 70491 70492	71250 74150	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
	71260 74150
	71270 74150
70490 70491 70492	71250 74160	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
	71260 74160
	71270 74160
70490 70491 70492	71250 74170	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
	71260 74170
	71270 74170
72128 72129 72130	72131 72132 72133	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
70450 70460 70470	71250 70490	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
	71260 70490
	71270 70490
70450 70460 70470	71250 70491	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
	71260 70491
	71270 70491
70450 70460 70470	71250 70492	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
	71260 70492
	71270 70492
70540 70542 70543	70547 70548 70549	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
70551 70552 70553	70540 70542 70543	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
70551 70552 70553	70544 70545 70546	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
70551 70552 70553	70547 70548 70549	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
71250 71260 71270	72192 72193 72194	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
71250 71260 71270	74150 74160 74170	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
72141 72146 72148		When all three are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72142 72147 72149		When all three are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72156 72157 72158		When any combination is billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72141 72142 72156	72146 72147 72157	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
72146 72147 72157	72148 72149 72158	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
72148 72149 72158	72141 72142 72156	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
72195 72196 72197	74181 74182 74183	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second
72156 72158 72147		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72158 72142 72147		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72158 72147 72141		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72156 72158 72146		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72158 72157 72142		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72158 72157 72141		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72158 72142 72146		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72158 72146 72141		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72156 72157 72149		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72157 72142 72149		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72157 72149 72141		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72156 72149 72147		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72149 72147 72141		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72156 72149 72146		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72142 72149 72146		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72149 72146 72141		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72156 72157 72148		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72157 72142 72148		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72157 72141 72148		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72156 72147 72148		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72142 72147 72148		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72147 72141 72148		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72156 72146 72148		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
72142 72146 72148		When column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
73218 73219 73220	73221 73222 73223	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 75% of the second
73718 73719 73720	73721 73722 73723	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 75% of the second
72197 72198 73725		When all three are billed together	100% of 72198, 50% of 73725, 0% of 72197
72198 74185 73725		When any combination is billed together	100% of the procedure with the highest RVU, 50% of the second and 50% of the third
70544 70545 70546	70547 70548 70549	When a code from column A is billed with a code from column B	100% of the procedure with the highest RVU, 75% of the second
70544 70545 70546	70547 70551	When a column A code is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 75% of the second and 50% of third
	70547 70552
	70547 70553
70544 70545 70546	70548 70551	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 75% of the second and 50% of third
	70548 70552
	70548 70553
70544 70545 70546	70549 70551	When a code from column A is billed with a pair of codes from column B	100% of the procedure with the highest RVU, 75% of the second and 50% of third
	70549 70552
	70549 70553
70496 70498 71275 73206 74175		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third or more
70496 70498 71275 73206 75635		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third or more
70496 70498 71275 73206 73706		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third or more
70496 70498 71275 73206 74174		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third or more
70496 70498 71275 73206 72191		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third or more
78306 78315		When billed together	100% of the procedure with the highest RVU, 50% of the second
76816 76817 76819 76820 76821		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third or more See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76770 76830 76705 76857		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third or more
76775	76857	When billed together	100% of 76775 and 25% of 76857*
76805 76820 76819		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76805 76817*		When billed together	100% of the procedure with the highest RVU, 50% of the second See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76700 76775 76830 76856		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third or more
76830 76856 76705 76775		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third or more
76770 76830 76705 76856		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third or more
76770 76830 76705 76857		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third or more
76705 76700 76770 76775		When three or more of the codes from column A are billed	100% of 76700, 50% of 76775, 0% for 76705, 0% for 76770
76825 76805 76817		When all three are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76700 76857 76830		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second and 25% of the third
76801 76813		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second Note: Horizon will only consider this code combination one per pregnancy. Only one code will be consider for reimbursement on subsequent submissions of this code combination. See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76801 76817		When any combination of column A codes are billed	100% of the procedure with the highest RVU, 50% of the second See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76820	76811 76815	When the column A code is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76820 76821 76811		When all three are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76816 76820 76821 76825		When any combination of column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third or more See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76821 76825 76827		When any combination of column A codes are billed together	100% of the procedure with the highest RVU, 50% of the second and 25% of the third See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76820	76815 76818	When the column A code is billed with a pair of codes in column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
	76815 76819
	76816 76819
	76816 76818
76821	76816 76818	When the column A code is billed with a pair of codes in column B	100% of the procedure with the highest RVU, 50% of the second and 25% of the third See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76821	76816 76819
76821	76805 76811 76812 76816	When the column A code is billed with a code from column B	100% of the procedure with the highest RVU, 50% of the second highest See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76825 76827		When billed together	100% of the highest RVU, 50% of the second highest See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76825 76828		When billed together	100% of the highest RVU, 50% of the second highest See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76826 76828		When billed together	100% of the highest RVU, 50% of the second highest See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76827 76826		When billed together	100% of the highest RVU, 50% of the second highest See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76811 76817 76820		When any combination of column A codes are billed	100% of the highest RVU, 50% of the second and 25% of the third See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76816 76828 76818		When any combination of column A codes are billed	100% of the highest RVU, 50% of the second and 25% of the third See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76817 76813		When billed together	100% of the highest RVU, 50% of the second See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.
76817 76815		When billed together	100% of the highest RVU, 50% of the second See eviCore’s Obstetrical Ultrasound Imaging Guidelines for additional information.