ACR Backs Fix to Burdensome Noridian TPE Reviews

ACR^® supports efforts to change Noridian Healthcare Solutions, LLC prepayment Targeted Probe and Educate review for CPT^® codes 74177, Computed tomography, abdomen and pelvis; with contrast material(s) and 72148, Magnetic resonance (e.g., proton) imaging, spinal canal and contents, lumbar; without contrast material. Radiology groups report major challenges meeting documentation requests for the professional component of these exams. In many hospitals, radiologists do not control the patient records needed for review, leading to high denial rates and financial strain on practices.

ACR and the Radiology Business Management Association asked Noridian Healthcare Solutions, LLC to exempt the professional component of these imaging services from prepayment review. They note that hospital based radiologists cannot access or compel ordering physicians to provide the required documentation.

The ACR Contractor Advisory Committee Network continues to review and respond to payer policies that directly affect radiology practices. This issue remains a top priority because of its impact on workflow, reimbursement and patient care.

The organizations welcome continued discussion with Noridian Healthcare Solutions, LLC leadership to resolve these concerns.

For questions about local coverage policies or this outreach, contact Alicia Blakey, ACR Manager of Economic Policy.