UCO reduction for multiple imaging tests

Performing multiple imaging tests in the same encounter has always raised questions in hospital billing, especially regarding the reduction of the Operational Cost Unit (UCO). With the publication of the CBHPM 2014, several regulatory guidelines were revised or removed, directly affecting how charges for Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Ultrasound (US) are interpreted.

But does the removal of these guidelines mean the end of the UCO reduction in these cases? That is what this article clarifies.

What is the UCO and why was it reduced for multiple tests?

The Operational Cost Unit (UCO) is a CBHPM component used to pay for the operating costs involved in performing medical procedures, especially diagnostic and therapeutic support tests.

Before 2014, the CBHPM provided that, when multiple imaging tests were performed in the same care encounter, there could be a reduction in the UCO value applied to the subsequent tests. This rule was intended to:

• avoid double charging for similar operating costs;

• reflect the efficiency gain from performing tests sequentially;

• standardize payment criteria between providers and payers.

This guideline was frequently used as the basis for audits and denials.

What changed with the CBHPM 2014 for CT, MRI and US?

With the CBHPM 2014, the specific guidelines on the second CT, MRI and US test were removed from the regulatory text.

In practice, this means that:

• there is no longer any explicit provision in the CBHPM for a UCO reduction;

• the table no longer prescribes automatic discounts on multiple tests;

• each procedure is now treated individually.

In other words, the CBHPM 2014 does not mandate a UCO reduction when more than one imaging test is performed in the same encounter.

Does the removal of the rule mean the tests are billed in full?

Yes, from a strictly regulatory standpoint, the most widely accepted interpretation is that, in the absence of an express provision, each test can be billed in full, including its respective UCO.

This is because the CBHPM is a reference table, and what is not provided for cannot be required as a general rule. In other words, there is no regulatory basis for applying an automatic reduction.

Many providers have used this understanding as a technical argument when appealing denials related to an improper UCO reduction.

Can payers still apply a UCO reduction?

Yes. Removing the rule from the CBHPM does not prevent health plans from adopting their own payment criteria, as long as they are clearly set out in the contract, known to the provider and do not conflict with the regulations in force.

That is why it is common to find payers that maintain internal policies of reducing amounts for multiple tests, even after 2014.

Why is contract review essential to avoid denials?

Most UCO-related denials do not stem from the CBHPM, but from:

• specific contract clauses;

• tables negotiated outside the CBHPM standard;

• payers’ internal audit rules.

Ignoring these documents can result in recurring denials, operational rework and lost revenue.

The recommendation is for billing and medical claims teams to always review the current contract with each payer, the applicable negotiated table and the specific rules for serial tests.

How to reduce UCO-related denials in hospital billing?

Some good practices include:

• standardizing contract interpretation between billing and internal audit;

• technically documenting full billing when there is no provision for a discount;

• using clinical and operational justifications in denial appeals;

• monitoring denial indicators by reason and by payer.

These actions increase billing predictability and reduce avoidable losses.