Current through Register Vol. 46, No. 39, September 25, 2024
(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 nonspecialist 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 nonspecialist, 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) interventional radiology;
(ii) screening and diagnostic radiology,
including ultrasound and nuclear medicine; or
(iii) 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
nonspecialist 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
subdivision (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 or solely for the technical and administrative component, as
defined in section
533.6(b)
of this Title, qualified practitioners who provide radiology services in their
offices must :
(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 or solely for the technical and
administrative component, as defined in section
533.6(b)
of this Title, qualified practitioners who provide radiology services in mobile
settings must :
(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
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 in private practice sends a film to a radiologist for professional
review, the practitioner must comply with paragraph (1) or (2) of this
subdivision and payment will be made solely for the technical and
administrative component as defined in section
533.6 of
this Title . The radiologist performing the read will be reimbursed solely for
the professional component as defined in section
533.6 of
this Title.
(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.
