Medicare AdvantageReimbursementHigh impact
[Virginia] Reimbursement policy update: Multiple Radiology Payment Reduction
Anthem BCBS·VA · Radiology·Claims & Billing
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem will expand its Multiple Radiology Payment Reduction policy to include CT scan services for Medicare Advantage plans in Virginia. 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 will be reimbursed at 100%; additional procedures will receive reduced payment.
Action Required
By March 15, 2026: Billing team must review the full Multiple Radiology Payment Reduction policy at https://anthem.com/provider to identify all affected CT scan CPT codes and procedures with CMS MPI indicator of 4. Update billing system edits and claim scrubbing logic to automatically apply the multiple procedure payment reduction when multiple qualifying imaging procedures are billed on the same date of service by the same provider group. Communicate to providers that when ordering multiple radiology procedures on the same encounter, only the highest-allowance component will receive full reimbursement. Failure to implement these changes may result in incorrect claim submissions and subsequent payment adjustments or denials from Anthem.