Medicare AdvantageReimbursementMedium impact
[Georgia] Reimbursement policy update: Multiple Radiology Payment Reduction
Anthem BCBS·GA · Radiology·Claims & Billing
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem Medicare Advantage in Georgia will expand its Multiple Radiology Payment Reduction policy to include CT scan services. When multiple diagnostic imaging procedures with CMS MPI indicator of 4 are performed by the same provider on the same date of service, only the highest-allowance component receives 100% reimbursement; additional procedures are reduced. Billing teams must identify bundled radiology claims and apply appropriate payment reductions.
Action Required
By March 31, 2026: Billing team must review and update billing system rules to identify multiple CT scan services billed on the same date of service by the same provider group. Implement logic to apply payment reductions to all procedures except the one with the highest allowance (whether global, professional, or technical component). Train billing staff to recognize claims subject to MPI 4 multiple procedure reductions. Audit claims submitted between April 1-30, 2026 to ensure proper reduction application. Contact Anthem at https://anthem.com/provider for detailed policy specifications including which specific CT scan codes trigger the reduction. Failure to apply reductions may result in overpayment recovery or recoupture by Anthem.