Effective 1/1/2017, claims for X-rays using film must include modifier FX. This modifier will trigger a 20 percent reduction in the payment amount for the technical component or the technical component portion of the global fee.
The reason codes for these claims will be:
- Claim Adjustment Reason Code 237 – Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
- Remittance Advice Remarks Code N775 – Payment adjusted based on x-ray radiograph on film.
I will be sending these over to the Help Desk to add to the default reason code library.
The patient is not liable for this payment reduction.
This is being done to comply with the Consolidated Appropriations Act of 2016 (Section 502(a)(1)) titled Medicare Payment Incentive for the Transition from Traditional X-Ray Imaging to Digital Radiography and Other Medicare Imaging Payment Provision.