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Florida BlueCommercial · Documentation · Claims & Billing · FL · RadiologyMedium impact

Radiology Billing Changes: HEDIS LBP Impact

Act
immediately
Effective date
Not stated in the notice
Identified
Jun 16, 2026

Summary

Florida Blue updated HEDIS specifications for low back pain imaging studies, requiring radiology providers to include ALL relevant ICD-10 codes from referrals, including exclusion codes like trauma history, to ensure accurate patient inclusion/exclusion in quality measures.

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What to do

immediately · 3 steps
01Billing team must update radiology claim submission process to capture and submit ALL ICD-10 codes from low back pain imaging referrals, including exclusion codes (e.g., trauma codes like G89.11 alongside low back pain codes like M54.5).
02Review current LBP imaging claims to ensure complete code submission.
03Contact HEDISInnovations@BCBSFL.com with questions.

Codes mentioned

G89.11M54.5

Original notice

Radiology Billing Changes: HEDIS LBP Impact
files.guidewell.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Florida Blue policiesFL policy changesRadiologyCode G89.11Code M54.5

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