Medicare AdvantageReimbursementMedium impact
[Ohio] Reimbursement policy update: Multiple Radiology Payment Reduction
Anthem BCBS·OH · Radiology·Claims & Billing
Effective date
Apr 1, 2026
We identified it
May 8, 2026
Summary
Effective April 1, 2026, Anthem Medicare Advantage in Ohio is expanding its Multiple Radiology Payment Reduction policy to include CT scan services. When multiple diagnostic imaging procedures with CMS NPFS multiple procedure indicator (MPI) of 4 are performed by the same provider on the same date of service during the same encounter, only the highest-allowance component will be reimbursed at 100%; additional procedures will receive reduced payment.
Action Required
By March 31, 2026: Billing team and providers must review the expanded Multiple Radiology Payment Reduction policy to identify CT scan procedures now subject to multiple procedure payment reduction rules. Update billing system edits and claim scrubbing logic to apply MPI 4 reduction rules to CT scans in addition to existing radiology procedures. Communicate to radiology and ordering providers that multiple imaging procedures on the same date of service will trigger payment reduction for all but the highest-allowance component. Review historical claims patterns to identify bundling scenarios. Failure to apply the reduction may result in overpayment recovery or claim denials on subsequent audits.