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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.
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.