Section 5160-11-21 - Portable x-ray supplier services(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;(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
Ohio Admin. Code 5160-11-21
Effective: 1/1/2021
Five Year Review (FYR) Dates: 01/01/2026
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 04/07/1977, 09/19/1977, 12/21/1977, 12/30/1977, 06/03/1983, 10/01/1983 (Emer.), 12/29/1983, 10/01/1984, 10/01/1984 (Emer.), 12/30/1984, 01/01/1986, 05/09/1986, 06/01/1986, 06/16/1988, 01/13/1989 (Emer.), 04/13/1989, 09/01/1989, 02/17/1991, 04/01/1992 (Emer.), 07/01/1992, 09/02/1992 (Emer.), 12/01/1992, 04/30/1993 (Emer.), 07/01/1993, 12/01/1993, 03/31/1994, 12/29/1995 (Emer.), 02/01/1996 (Emer.), 03/21/1996, 04/04/1996, 12/31/1997 (Emer.), 03/19/1998, 12/31/1998 (Emer.), 03/31/1999, 08/01/2001, 02/02/2003, 04/01/2004, 12/30/2005 (Emer.), 03/27/2006, 05/25/2006, 12/31/2007 (Emer.), 03/30/2008, 06/01/2009, 04/01/2016, 01/01/2018