Sorry, you need to enable JavaScript to visit this website.

Title: Section 505.17 - Radiology services.

505.17 Radiology services. (a) Scope. This section describes the department's policies governing the provision of and payment for radiology services under the Medical Assistance (MA) program.

(b) Purpose. The MA program will pay for medically necessary radiology services provided by qualified practitioners as described in this section and in the settings authorized by this section.

(c) Definitions. (1) Dentist means a dentist who is qualified in accordance with Part 506 of this Title.

(2) Physician non-specialist means a physician who is qualified in accordance with section 505.2 of this Part.

(3) Physician specialist means a physician, other than a radiologist, who is qualified as a specialist in accordance with section 505.2 of this Part.

(4) Podiatrist means a podiatrist who is qualified in accordance with section 505.12 of this Part.

(5) Qualified practitioner means a radiologist, physician specialist, physician non-specialist, dentist or podiatrist as defined in this section.

(6) Radiologist means a physician who is qualified as a specialist in radiology in accordance with section 505.2 of this Part.

(7) Radiology services means the provision of the following services to MA recipients:

(i) diagnostic radiology;

(ii) diagnostic ultrasound;

(iii) nuclear medicine; or

(iv) radiation oncology.

(8) Mobile setting means those radiology services provided by a qualified practitioner which are not performed in the practitioner's office and includes those services which use portable equipment for the provision of radiology services.

(d) Who can provide radiology services. Radiology services can be provided only by the following qualified practitioners and with the following limitations:

(1) A radiologist;

(2) A physician specialist may provide radiology services related and limited to the physician's area of specialty;

(3) A physician non-specialist may provide radiology services as medically necessary, but such services must be limited to routine diagnostic chest x-rays and/or diagnostic x-rays for acute injuries; and

(4) Dentists and podiatrists may provide radiology services related and limited to their scope of practice.

(e) Where radiology services can be provided. Qualified practitioners, as defined in this section, may provide radiology services in their offices, in mobile settings or in facilities certified under Article 28 of the Public Health Law. In each such instance the requirements of subdivisions (f) of this section must be met.

(f) Limitations on payment for radiology services.

(1) In order to be paid for both the professional and the technical and administrative components of the radiology service, as defined in section 533.6(b) of this Title, qualified practitioners who provide radiology services in their offices must perform the professional component of radiology services as set forth in section 533.6 of this Title and:

(i) own or directly lease the equipment and must supervise and control the radiology technicians who perform the radiology procedures; or

(ii) be the employees of physicians who own or directly lease the equipment and must supervise and control the radiology technicians who perform the radiology procedures.

(2) In order to be paid for both the professional and the technical and administrative components of the radiology services, as defined in section 533.6(b) of this Title, qualified practitioners who provide radiology services in mobile settings must perform the professional component of radiology services as set forth in section 533.6 of the Title and:

(i) own or directly lease the equipment and must employ the radiology technicians who perform the radiology procedures; or

(ii) be the employees of physicians who own or directly lease the equipment and such physicians must employ the radiology technicians who perform the radiology procedures.

(3) A qualified practitioner who provides radiology services in a facility certified under Article 28 of the Public Health Law which owns or leases the equipment and in which the professional component is not included in the facility's MA payment rate as established by the Department of Health and approved by the Director of the Budget will be paid only the professional component of the radiology services as defined in section 533.6 of this Title. No payment will be made to a qualified practitioner solely for the technical and administrative component of radiology services provided in such a facility.

(4) If a qualified practitioner sends a film to a radiologist for professional review, no payment will be made to the radiologist. The cost of such professional review is a cost of doing business to the qualified practitioner providing the radiology service.

(g) Leasing of radiology equipment. Payments for leasing radiology equipment must be based on the reasonable costs of furnishing and maintaining the equipment leased, must not be based on a percentage of fees billed or received for radiology services, and must be in compliance with federal and State law and regulations pertaining to kickbacks and other illegal payment or repayment arrangements.

Volume

VOLUME C (Title 18)

up