This is only a notification of the policy that will be effective 05/18/2010. For the current version of the policy click the following link: 09.00.23a Therapeutic Radiology Port Films
In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
Company Benefit Contracts.
Highmark Medicare Services. Local Coverage Determination (LCD).L27515: Radiation therapy services. [Highmark Medicare Services Web site]. Original: 07/11/08. (Revised: 01/14/10). Available at:
Accessed January 14, 2010.
Policy: 03.00.20i:Modifiers 26 (Professional Component) and TC (Technical Component)