5101:3-11-06 Portable x-ray suppliers: covered services and limitations.

(A) Portable x-ray services are limited to the following radiology services:

(1) Skeletal films involving the extremities, pelvis, vertebral column, and skull;

(2) Chest films that do not involve the use of contrast media;

(3) Abdominal films that do not involve the use of contrast media.-and;

(4) Diagnostic mammograms if the provider meets the requirements in 21 C.F.R. (April 1, 2005) part 900 subpart B.

(B) Procedures and examinations that are not covered when provided by a portable x-ray provider include:

(1) Procedures involving fluoroscopy;

(2) Procedures involving the use of contrast media;

(3) Procedures requiring the administration of a substance to the patient or the injection of a substance into the patient and/or special manipulation of the patient;

(4) Procedures that require special medical skill or knowledge possessed by a doctor of medicine or doctor of osteopathy, or that require that medical judgment be exercised;

(5) Procedures requiring special technical competency and/or special equipment or materials;

(6) Routine screening procedures; and

(7) Procedures that are not of a diagnostic nature.

(C) Reimbursement is available for the transportation of portable x-ray equipment to a patient's home, or to a long-term care facility (LTCF). In a LTCF, only one such charge per visit, to the supplier is allowed, regardless of the number of patients seen.

(D) For a portable x-ray service to be covered under medicaid:

(1) The service must be medically necessary as defined under rule 5101:3-1-01 of the Administrative Code; and

(2) The service must be requested by a physician in writing.

(a) The service may be performed on the verbal request of a physician but the laboratory must obtain a written order dated and signed by the physician before the services may be billed to the department.

(b) The physician's order must specify the reason the x-ray is medically necessary and must specify the x-ray procedure(s) to be performed, including the number of radiographs to be obtained and the views needed.

(c) The service must be performed under the general supervision of a physician.

(E) The portable x-ray supplier must keep the following records for each patient for a period of at least six years:

(1) The date of the x-ray examination;

(2) A copy of the written, signed and dated order by the patient's physician;

(3) The name of the operator(s) of the portable x-ray equipment; and

(4) The name of the physician who performed the professional interpretation of the procedure and the date the radiograph was sent to the physician.

(F) Billing for portable x-ray supplier services.

(1) Portable x-ray suppliers may bill for the total procedure of a covered x-ray service if the supplier provided both the technical and the professional components of the procedure.

(a) For the supplier to be eligible for reimbursement of the total procedure, the professional component must be provided by a qualified physician who either owns, is employed by or is under contract with the portable x-ray supplier.

(b) To bill for the total procedure of a covered portable x-ray service, the provider must bill the CPT code, in accordance with division-level 5101:3 of the Administrative Code, for the procedure without a modifier.

(2) Portable x-ray suppliers may only bill for the technical component when the supplier performed the technical services and a physician not associated with the supplier by ownership, employment, or contract provided the professional services (e.g., the patient's treating physician interpreted the x-ray procedure).

To bill for the technical component, the provider must bill the CPT code for the procedure followed by the modifier TC (e.g., 71010TC).

(3) A portable x-ray supplier may not bill separately for the professional component.

Effective: 05/25/2006
R.C. 119.032 review dates: 03/09/2006 and 05/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02
Prior Effective Dates: 4/7/77, 9/19/77, 12/21/77, 12/30/77, 10/1/84 (Emer), 12/30/84, 6/1/86, 2/17/91, 8/1/01