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 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.
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. |