by Wyn Staheli, Director of Research
February 7th, 2019
Are you aware if digital x-ray of the spine requires a different code than plain x-ray? If so, where can I find the information specific to digital x-ray codes?
There are no separate codes for digital x-rays. However, there may be modifiers that are required to be submitted with the usual imaging codes. The Consolidated Appropriations Act of 2016, titled "Medicare Payment Incentive for the Transition from Traditional X-Ray Imaging to Digital Radiography and Other Medicare Imaging Payment Provision" makes it clear that Medicare wants providers to use digital imaging and like EHR, they will penalize you for not using the newer technology.
Effective January 1, 2017, Medicare requires modifier FX if the image is done with film. This modifier reduces payment of the technical component (and the technical component of the global fee) by 20 percent. It is important to note that this reduction ONLY applies to the technical component. This fee reduction can not be passed on to the beneficiary.
Effective January 1, 2018, Medicare also began to require modifier FY when the image utilizes computed radiography technology which Medicare defines as "cassette-based imaging which utilizes an imaging plate to create the image involved." This modifier reduces the payment by 7% until 2023 when it increases to 10 percent reduction.
Note: If an imaging service has both computed radiography (CR) technology and images taken using digital radiography (DR) views, then there will be no payment reduction.
Even though Medicare does not cover imaging taken by doctors of chiropractic, it is apparent that some other payers are also beginning to require these new modifiers. For example, Aetna’s March 2017 newsletter states that they require modifier FX as of June 1, 2017. Moda Health seems to be following suit. Another payer policy that we found stated that although they require modifier FX now, they would not be reducing payment, but that policy was dated March 2017 so they may have updated their policy since that time.
Bottom line is that regardless of payer, we are recommending that you use these new modifiers on every applicable claim. Please note that “accidentally forgetting” to include them does not exclude you and future payer audits will require you to pay back the insurance amounts incorrectly paid.