UHC Radiology Requirement

[gaschicago]

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How are you all navigating the new UHC radiology requirement that a separate report needs to be available if the practice is going to bill for the x ray separate to the E/M?

Does this introduce any increased legal liability for missed incidental findings?

For those in orthopedic group practices where x ray revenue falls under ancillary services, are you asking to have the professional component reimbursement or RVU count towards your collections?

 

[BobBarker]

I don’t think most of us do this. I would assume 99% don’t.

 

[gaschicago]

Professional/Technical Component Policy, Professional
April 1, 2026
• Effective for dates of service on or after April 1, 2026, UnitedHealthcare will enhance the Professional/Technical Component Policy, Professional. When a radiology service is rendered and the physician or other eligible qualified healthcare professional performs a review rather than the full written interpretation and report, the reimbursement for the professional component is considered included in the Evaluation and Management (E/M) service. This will occur whether the radiology service is billed globally or with modifier 26.

• Effective October 1, 2024, the Professional/Technical Component Policy was enhanced so the interpretation of a radiology service appended with modifier 26 would not be considered for separate reimbursement when reported on the same date of service as an E/M service for the same patient by the same provider unless a copy of the radiology report was attached to support separate reimbursement.

• With the current enhancement, when a global radiology code is billed on the same date of service as an E/M service for the same patient, by the same individual provider, the global radiology code’s professional component will not be considered for separate reimbursement unless a copy of the radiology report is attached to support separate reimbursement. For example, if an internal medicine provider bills for an E/M service and a global radiology service, the provider would need to submit the report for the professional component of the global radiology service to be considered for separate reimbursement.

• To help providers submit an interpretation report, a Smart Edit will be implemented which provides additional details regarding the process for submitting the full interpretation report.

https://www.uhcprovider.com/content...bursement/rpub/UHC-COMM-RPUB-January-2026.pdf

Are your practices just billing the technical component for x rays done in office? I believe ours is billing for the both technical and professional and labeling it as ancillary collections.

 

[nvrsumr]

Cut #1001