Current through Register Vol. 46, No. 39, September 25, 2024
(a) Maximum payment
for radiology services. The department will reimburse providers of radiology
services according to the radiology fees listed in the relevant Radiology Fee
Schedule at
https://www.emedny.org/ProviderManuals/Radiology/index.aspx
or
https://www.emedny.org/ProviderManuals/OrderedAmbulatory/index.aspx.
Unless otherwise indicated, these fees are full payment for the radiology
service provided.
(b) Radiology fee
components. The fees listed in each Radiology Fee Schedule set forth in
subdivision (a) of this section include payment for the professional component
and/or the technical and administrative component of radiology services.
(1) Professional component. The professional
component of radiology services refers to the various professional services
performed by physicians, including:
(i)
(a) for interventional radiology services,
determining the patient's problem, including interviewing the patient,
obtaining the patient's medical history, and examining the patient to decide
how to perform radiology procedures;
(b) for diagnostic radiology services,
reviewing relevant clinical information as presented by the ordering or
referring physician, including the basis for performing the radiology
study;
(ii) studying the
results of diagnostic or therapeutic procedures, interpreting X-rays or
radioisotope data and estimating treatment results;
(iii) dictating examination or treatment
reports; and
(iv) consulting with
and furnishing written reports to referring physicians regarding the results of
diagnostic or therapeutic procedures.
(2) Technical and administrative component of
radiology services. The technical and administrative component of radiology
services refers to various services, including the following:
(i) use of personnel, such as technologists
and clerical staff;
(ii) use of
supplies such as film, opaques, radioactive substances, chemicals and drugs;
and
(iii) purchase, rental or
maintenance of space, equipment, telephones or other related
supplies.
(3) Procedures
not separable into professional and technical and administrative components.
Injections of radiopaque media, fluoroscopy and consultations must be performed
by the physician. Consequently, these procedures are not separated for billing
into professional and technical and administrative components, and the total
fee listed in the relevant Radiology Fee Schedule set forth in subdivision (a)
of this section for such services is paid to the physician.
(c) Reimbursement.
(1) Physicians who render both the
professional and technical and administrative components of a radiology service
must meet the requirements of section
505.17 of this
Title and will be reimbursed the global fee listed in the relevant Radiology
Fee Schedule set forth in subdivision (a) of this section.
(2) Physicians who render solely the
professional component of a radiology service will be reimbursed the
professional fee listed in the relevant Radiology Fee Schedule set forth in
subdivision (a) of this section.
(3)
Physicians who render solely the technical and administrative component of a
radiology service must meet the requirements in section
505.17 of this
Title and will be reimbursed the technical and administrative fee listed in the
relevant Radiology Fee Schedule set forth in subdivision (a) of this
section.
(4) Hospitals that render
both the professional and technical component of a radiology service will be
reimbursed the global fee listed in the relevant Radiology Fee Schedule set
forth in subdivision (a) of this section.
(5) Hospitals that render solely the
technical and administrative component of a radiology service will be
reimbursed the technical and administrative fee listed in the relevant
Radiology Fee Schedule set forth in subdivision (a) of this
section.
(d) General
rules. These rules apply to all procedure codes found in the Radiology Fee
Schedule.
(1) What is included in radiology
fees. Fees listed in the Radiology Fee Schedule include the following:
(i) the usual contrast media, equipment and
materials. When the physician supplies special surgical trays or materials, an
additional charge may be claimed from the department;
(ii) consultation with and written reports
provided to the referring physician; and
(iii) payment for injection procedures, such
as local anesthesia, needle or catheter placement or injection of contrast
media as provided in the Radiology Fee Schedule, except for injection
procedures which are identified by an asterisk before the code in the Radiology
Fee Schedule.
(2) Payment
for multiple or repeat radiology procedures.
(i) When more than one radiology procedure is
performed on different parts of the body during the same visit, the total
payment is the sum of the fee for the more costly procedure plus 60 percent of
the fee for the less costly procedure.
(ii) When a single radiology procedure is
performed which shows more than one part of the body, payment will be made for
only one procedure.
(iii) When
repeat radiology procedures are performed on the same part of the body and for
the same illness, payment for the repeat procedures will be made according to
the fee listed in the Radiology Fee Schedule. However, no payment will be made
for repeat procedures on the same part of the body and for the same illness
when the reason for the repeat procedure is technical or professional error in
the original procedure.
(e) Outpatient and clinic services. No
additional payment will be made for outpatient emergency and clinic services if
the cost of providing radiology or radiotherapy services is included in the
maximum reimbursement rate promulgated for the hospital by the Director of the
Budget pursuant to section 2807 of the Public Health Law. When
physicians refer patients for outpatient radiology or radiotherapy services,
payment will be made according to the Radiology Fee Schedule except when
radiology or radiotherapy services are provided in a facility that includes the
cost of these services in its clinic rate calculation. In these cases, the
recipient shall be registered as a clinic patient and the clinic rate shall be
billed.
(f) Current Procedural
Terminology ( CPT) code modifiers. Each radiology procedure listed in the
Radiology Fee Schedule s set forth in subdivision (a) of this section is
preceded by a five-digit number identifying the specific procedure for which
payment is claimed. Known as a CPT procedure code, this number sometimes must
be expanded by two additional digits, or modifiers, to describe more completely
the particular procedure involved. The modifiers used in radiology are are
found in the relevant Radiology Fee Schedule set forth in subdivision (a) of
this section.
