Radiology services

Members are required to obtain a Physician order and/or a Referral to receive radiology services. Additionally, there are certain high-technology diagnostic services that require Preapproval, and IBC has delegated this responsibility to AIM Specialty HealthSM (AIM).

Payment will be made directly to the facility according to the hospital’s contracted rates. Reimbursement for radiology services is a global (i.e., technical and professional component) payment. Please refer to the current Correlation Edits for Outpatient Claims document, which is updated and distributed each quarter, when determining which revenue codes and HCPCS and/or CPT codes to use for billing.

Capitated services 

Radiology services for HMO/POS Members are generally provided by the designated Participating Provider under the Capitated Diagnostic Radiology Program. A complete listing of the services included in this program can be found at www.ibx.com/medpolicy. Radiology services that are excluded from capitation are paid at the hospital’s contracted rate. 

Interventional radiology 

Interventional radiology (IR) involves procedures with both a surgical and radiological component. In addition to a surgical revenue code and correlated surgical procedure code, claims also should be submitted with a radiology revenue code and correlated radiology procedure code. The surgical procedure code is reimbursed and includes the radiology services.

Short-term rehabilitation therapy services 

Short-term rehabilitation therapy services are reimbursed in accordance with IBC’s medical policies, which can be found at www.ibx.com/medpolicy. Payment will be made directly to the facility according to the hospital’s contracted rates. Please refer to the current Correlation Edits for Outpatient Claims document, which is updated and distributed each quarter, when determining which revenue codes and HCPCS and/or CPT codes to use for billing. 

Capitated services 

Physical therapy and occupational therapy services for HMO/POS Members are generally provided by the designated Participating Provider under the Capitated Outpatient Short-Term Rehab Program. A complete listing of the services included in this program can be found at www.ibx.com/medpolicy. Therapy services that are excluded from capitation are paid at the hospital’s contracted rate. 

Sleep study (neurology) 

In order for a participating hospital’s sleep study program to be eligible as an approved sleep study program for IBC’s network, the program must be accredited by the Joint Commission or the American Association of Sleep Medicine, as specifically referred to in your Agreement. For hospital billing, sleep study is part of the neurology fee schedule and should be billed using neurological revenue codes. 

Revenue codes requiring HCPCS/CPT codes

 When billing one of the revenue codes listed below, a corresponding HCPCS/CPT code must be reported on the claim line. 

Revenue code series - 02xx

Revenue codes  -  0250-0256, 0258-0261, 0269, 0274-0275, 0278, 0280, 0289-0294, 0299

Revenue code series - 03xx

Revenue codes  - 0300-0312, 0314, 0319-0324, 0329-0333, 0335, 0339-0344, 0349-0352, 0359- 0362, 0367, 0369, 0374, 0380-0387, 0389-0381, 0399 

Revenue code series - 04xx

Revenue codes  - 0400-0404, 0409-0410, 0412-0413, 0419-0424, 0429-0434, 0439-0444, 0449- 0452, 0456, 0459-0460, 0469-0472, 0479-0483, 0489-0490, 0499 

Revenue code series - 05xx

Revenue codes  - 0510-0517, 0519, 0530-0531, 0539

Revenue code series - 06xx

Revenue codes  - 0610-0612, 0614-0616, 0618-0619, 0621-0623, 0631-0637

Revenue code series -07xx 

Revenue codes  - 0700, 0720-0723, 0729-0732, 0739-0740, 0750, 0760-0762, 0769, 0771, 0790

Revenue code series - 08xx

Revenue codes  - 0820-0825, 0829-0835, 0839-0845, 0849-0855, 0859-0861, 0880-0881, 0889

Revenue code series - 09xx

Revenue codes  - 0901, 0903, 0914-0918, 0920-0925, 0929, 0940-0949, 0951-0952