Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-11 - Independent Laboratory and X-Ray Services
Section 5160-11-21 - Portable x-ray supplier services
Universal Citation: OH Admin Code 5160-11-21
Current through all regulations passed and filed through September 16, 2024
(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).
(B) Coverage.
(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.
Replaces: 5160-11- 03.2, part of 5160-11-01, part of 5160-11-02, part of 5160-11-09
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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