Rule 5160-11-21 | Portable x-ray supplier services.
(A) Providers. An entity may enroll in medicaid as a portable x-ray supplier only if it complies with the conditions set forth in 42 C.F.R. part 486 subpart C (October 1, 2020).
(1) The radiology procedures performed by a portable x-ray supplier have both a professional component and a technical component.
(a) In general, a portable x-ray supplier performs the technical component of a procedure.
(b) A portable x-ray supplier may receive payment for the technical component alone if it performs only the technical component and the professional component is performed by a physician or other qualified healthcare professional not associated with the portable x-ray supplier by ownership, employment, or contract (e.g., interpretation of an x-ray is performed by an individual's treating practitioner).
(c) A portable x-ray supplier may receive payment for a global procedure if it performs both the professional and the technical components and the professional component is performed by a physician or other qualified healthcare professional who owns, is employed by, or is under contract with the portable x-ray supplier.
(d) A portable x-ray supplier cannot receive payment for the professional component alone.
(2) For payment purposes, only the following radiology procedures are considered to be portable x-ray services:
(a) Skeletal imaging involving the extremities, pelvis, vertebral column, and skull;
(b) Chest imaging;
(c) Abdominal imaging; and
(d) Diagnostic mammography if the provider meets the conditions set forth in 21 C.F.R. part 900 subpart B (April 1, 2020).
(3) Provisions affecting payment for radiology services are set forth in rule 5160-4-25 of the Administrative Code.
(4) No payment is made for the following procedures when they are performed by a portable x-ray supplier:
(a) Procedures involving fluoroscopy;
(b) Procedures involving the use of a contrast medium;
(c) Procedures involving the administration of a substance to the individual, the injection of a substance into the individual, or special manipulation of the individual;
(d) Procedures involving special medical skill or knowledge possessed by a physician or other qualified healthcare professional or the exercise of medical judgment;
(e) Procedures involving special technical competency or special equipment or materials not ordinarily needed for radiography;
(f) Routine screening procedures; and
(g) Procedures that are not of a diagnostic nature.
(5) Payment is available for the one-way transportation of portable x-ray equipment to a medicaid-eligible individual's place of residence. For each visit, only one equipment transportation charge is allowed, regardless of the number of persons served.
(C) Claim payment. For a covered global radiology procedure and its professional and technical components and for covered transportation of portable x-ray equipment, the medicaid maximum payment amounts are indicated in appendix DD to rule 5160-1-60 of the Administrative Code.
Five Year Review Date: 1/1/2026
Prior Effective Dates: 4/7/1977, 9/19/1977, 12/21/1977, 12/30/1977, 6/3/1983, 10/1/1983 (Emer.), 12/29/1983, 10/1/1984 (Emer.), 10/1/1984, 12/30/1984, 1/1/1986, 5/9/1986, 6/1/1986, 6/16/1988, 1/13/1989 (Emer.), 4/13/1989, 9/1/1989, 2/17/1991, 4/1/1992 (Emer.), 7/1/1992, 9/2/1992 (Emer.), 12/1/1992, 4/30/1993 (Emer.), 7/1/1993, 12/1/1993, 12/30/1993 (Emer.), 3/31/1994, 12/29/1995 (Emer.), 2/1/1996 (Emer.), 3/21/1996, 4/4/1996, 12/31/1997 (Emer.), 3/19/1998, 12/31/1998 (Emer.), 3/31/1999, 8/1/2001, 2/1/2003, 4/1/2004, 12/30/2005 (Emer.), 3/27/2006, 5/25/2006, 12/31/2007 (Emer.), 3/30/2008, 6/1/2009, 4/1/2016, 1/1/2018, 6/12/2020 (Emer.)