Saturday, September 10, 2016

PROCEDURE CODE 73620, 73630 - Foot Radiology Exam


Radiology Codes          Procedure Description

PROCEDURE CODE 73620 - Radiologic examination, foot; 2 views Avergae fee amount $25 - $40

Procedure Code 73630 - Radiologic examination, foot; complete, minimum of 3 views - Avergae fee amount $25 - $40



Procedure Code Mod Descriptor 2013 Payment Rate 2014 Payment Rate % Change in Payment Rate

73620 X‐ray exam of foot $28.58 $27.94 ‐2.23%
73620 26 X‐ray exam of foot $7.49 $7.88 5.29%
73620 TC X‐ray exam of foot $21.09 $20.06 ‐4.90%

73630 X‐ray exam of foot $32.66 $32.24 ‐1.29%
73630 26 X‐ray exam of foot $8.17 $8.60 5.29%
73630 TC X‐ray exam of foot $24.50 $23.64 ‐3.48%


VA Billing Guidelines

• Agreed with QTC’s recommendation to use the standard Procedure code, 73630, for a complete x-ray of the foot, but without the internal QTC modifiers. Asked QTC to make price adjustments for the time period May 1, 2003 through October 15, 2006, for the overpayments caused by using the proprietary codes.





Electronic Claim Alert:

Duplicate Modifier Rejections to Begin June 19, 2013

Electronic claims (ANSI 837P and 837I) containing duplicate modifiers on a single service line will begin rejecting as of June 19, 2013, when submitted to Blue Cross and Blue Shield of Illinois (BCBSIL) through Availity®

Claims submitted to BCBSIL from Passport/Nebo Systems will begin rejecting effective June 21, 2013.

An example of a submission with duplicate modifiers on a single service line is as follows: Current Procedural Terminology (Procedure ® ) code 73630 with modifiers 26, RT, RT.


This edit will apply to professional claims (Loop 2400, SV101-6) and institutional claims (Loop 2400, SV202- 6). To help ensure your claims are accepted, please review them prior to submission to verify that you have  not duplicated any modifiers on a single service line.

If you use a billing service or clearinghouse, please make sure they are aware of this information. If you have any questions regarding this notice, contact our Electronic Commerce Center at 800-746-4614.


NCCI EDIT for Procedure code 73630

The below codes are not paid separately unless there is a Modifiers

36591 36592 73620


Repeat Radiological Procedures (Modifiers 76 and 77) – these modifiers are used when an X-ray procedure is being repeated on the same day. These modifiers will help identify that services are not duplicate billing problems but medically necessary repeat procedures. Therefore, a medical documentation must be submitted indicating the time the service was rendered on your initial submission.

Modifier 76– appended to the Procedure Code when repeated by the same physician on the same day.
Modifier 77– appended to the Procedure Code when repeated by another physician on the same day.

Please note: Medicare considers all physicians in the same group practice with the same specialty to  be the same physician


EXAMPLE: 73630-26 

73630-26-76 (Dr Johns) *** submit medical documentation
 73630-26-77 (Dr Adams) *** submit medical documentation

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