N.J. Admin. Code § 10:54-4.25

Current through Register Vol. 56, No. 19, October 7, 2024

Section 10:54-4.25 - Radiology; portable and mobile diagnostic

(a) Portable and mobile diagnostic radiological services shall be provided only by a physician who is a specialist in radiology.

(b) Portable and mobile diagnostic radiological services may be provided to Medicaid patients in long term care settings, in an emergency situation, or in a situation in which it is not medically practical to provide such services other than by bringing equipment and personnel to the patient for whom these services are indicated. No portable or mobile diagnostic radiological services provided in a boarding home or independent clinical laboratory shall be reimbursed by Medicaid.

(c) Portable and mobile diagnostic radiological services shall conform with Federal, State and local laws and regulations.

(d) Portable radiological services shall be rendered only on the written order of a licensed health professional within the limits of his or her licensure. The physician/practitioner ordering the service shall:

1. Define the body area to be radiologically examined;

2. Provide the diagnosis(es) indicating the reason for the order;

3. Indicate the current clinical status of the patient; and

4. Indicate dates and types of previous radiological examinations within past year.

(e) Regardless of who retains the radiology film(s) after the service has been rendered (attending physician or portable radiological services);

1. Retention of such film(s) and written record(s) shall be consistent with State law.

2. Release of such film(s) and record(s) to other health professionals and/or facilities, who may subsequently be responsible for the patient's care, shall be allowed only with the written consent of the patient (or his or her legal representative) and the physician who ordered the study.

(f) Portable and mobile diagnostic radiology service records shall consist of, as a minimum:

1. Date(s) of examination;

2. Type of examination with radiologic findings and diagnosis (description of procedures ordered and performed);

3. Name of patient;

4. Place of examination;

5. Name and title of technician who performed the examination;

6. Name of radiologist who interpreted the film;

7. Name of referring physician;

8. Date report sent to referring physician; and

9. Whether film studies were retained by the service or forwarded to the referring physician with date forwarded.

(g) The professional component and technical component charges shall be combined, billed and reimbursed as one lump sum unless otherwise specified for portable X-rays. Transportation and setting up charges for portable X-rays is allowed for the first person only for an examination at a home or long term care settings. Reimbursement shall be limited to a single fee per trip at home or facility regardless of the number of persons X-rayed and shall include return for retakes due to technical errors.

(h) Reimbursement shall be made according to the Medicaid maximum fee allowance schedule for radiological services, contained N.J.A.C. 10:54-9.

(i) Reimbursement shall be all inclusive, in accordance with the schedule of allowances, and shall be payable only to the approved provider. Any subsequent arrangement for apportionment between the provider and personnel shall be consistent with standard practice of the medical profession.

(j) The provider shall identify the radiologist who interpreted the film in order to receive payment on the physician claim form (CMS 1500) on Item 24. If the provider is a radiologist, the physician referring the patient shall also be identified on the claim form (CMS 1500) on Item 17 and 17a.

N.J. Admin. Code § 10:54-4.25

Recodified from N.J.A.C. 10:54-4.24 by R.1998 d.154, effective 2/27/1998 (operative March 1, 1998; to expire August 31, 1998).
See: 30 N.J.R. 1060(a).
Former N.J.A.C. 10:54-4.25, Consultation services; general, recodified to N.J.A.C. 10:54-4.26.
Adopted concurrent proposal, R.1998 d.487, effective 8/28/1998.
See: 30 N.J.R. 1060(a), 30 N.J.R. 3519(a).
Readopted the provisions of R.1998 d.154 without change.
Amended by R.2001 d.51, effective 2/5/2001.
See: 32 N.J.R. 3929(a), 33 N.J.R. 555(a).
In (j), substituted "17 and 17a" for "24" in the second sentence.
Amended by R.2012 d.124, effective 7/2/2012.
See: 43 N.J.R. 1477(a), 44 N.J.R. 1884(a).
In (j), substituted "CMS" for "HCFA" twice.