Medicare AdvantageReimbursementMedium impact
[California] Reimbursement policy update: Multiple Radiology Payment Reduction
Anthem BCBS·CA · 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 members in California. 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 reimbursement.
Action Required
By March 31, 2026: Billing team must review current radiology bundling and multiple procedure reduction workflows to identify CT scan claims that will be affected. Update billing system rules and claims submission processes to apply the multiple procedure payment reduction to CT scans performed on the same date of service by the same provider group under Anthem Medicare Advantage plans in California. Audit recent CT scan claims submitted after January 1, 2026 for potential adjustment or resubmission once the policy takes effect. Train providers and clinical staff on the policy change to ensure they understand reimbursement will be reduced for multiple imaging on the same encounter. Reference the full policy at https://anthem.com/ca/provider for technical component, professional component, and global allowance details.