Section 433.437 - Radiology Services: Service LimitationsSee also the general limitations described at 130 CMR 433.407.
(A)Diagnostic Interpretations. When a physician provides the professional component (interpretation) of a diagnostic radiology service in a hospital inpatient or outpatient setting, the MassHealth agency pays for those services in accordance with the EOHHS fee schedule. The MassHealth agency does not pay for the interpretation of an X-ray that was previously read and taken in the same hospital. However, the MassHealth agency does pay a physician for interpreting an X-ray that was previously read and taken in a different hospital.(B)Therapeutic Interpretations. When a physician provides the professional component (interpretation) of a therapeutic radiology service in a hospital inpatient or outpatient setting, the MassHealth agency pays for those services in accordance with the EOHHS fee schedule.(C)Surgical Introductions and Interpretations. The MassHealth agency pays a physician for performing surgical introductions and interpretations of films performed in a hospital inpatient or outpatient setting, with the following restrictions. (1) Only one surgical introduction per operative session is payable in accordance with the EOHHS fee schedule.(2) In a single operative session:(a) no more than three additional surgical introductions using the same puncture site are payable, each in accordance with the EOHHS fee schedule; and(b) no more than three additional selective vascular studies using the same puncture site are payable, each at the maximum allowable fee.(3) Interpretations are payable in accordance with the EOHHS fee schedule, up to a maximum of three.(D)Duplicate Services. Two or more identical diagnostic or therapeutic radiology services performed on one day for a member by one or more physicians are payable only if sufficient documentation for each is shown in the member's medical record.(E)Interventional Radiology. If interventional radiology services are performed by two providers, the professional component is divided equally into surgical and interpretative components.Amended by Mass Register Issue S1345, eff. 8/11/2017.