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Printed Date: 9/22/2015
Portable X-Ray Services
42 CFR 486.106 outlines the specific conditions for coverage for portable X-ray examinations. The regulations summarize the 'referral for service' and 'preservation of records' for portable X-ray examinations, they are as follows:
Referral of Services
Portable X-ray examinations are performed only on the order of a physician licensed to practice in the state or by a nonphysician practitioner acting within the scope of state law. The supplier's records show that:
Tests not ordered by the physician who is treating the beneficiary are not reasonable and necessary, and therefore, would not be a covered service under the Medicare program.
Preservation of Records
The portable X-ray supplier should create for each patient a record of the date of the portable X-ray examination, the name of the patient, a description of the procedures ordered and performed, the referring physician or nonphysician practitioner, the operator(s) of the portable X-ray equipment who performed the examination, the physician to whom the radiograph was sent, and the date it was sent.
Such reports are to be maintained for a period of at least two years, or for the period of time required by State law for such records (as distinguished from requirements as to the radiograph itself), whichever is longer.
In 42 CFR 424.5 (A) (6), it's stated that, ‘The provider, supplier or beneficiary, as appropriate, must furnish to the intermediary or carrier sufficient information to determine whether payment is due and the amount of payment.’ The patient’s medical records should contain enough information to substantiate the claim submitted to Medicare. For portable X-ray services, that includes the documentation outlined above in the ‘Referral of Services’ section. If required information is missing in the submitted medical record, the claim will be considered invalid, and steps will be taken to recover Medicare funds from the supplier.
Additional Portable X-ray Requirements
Diagnostic X-ray services furnished by a portable X-ray supplier are covered under Part B when furnished in a place or residence used as the patient’s home and in non-participating institutions. These services must be performed under the general supervision of a physician, the supplier must meet FDA certification requirements and certain conditions relating to health and safety must be met.
Diagnostic portable X-ray services are also covered under Part B when provided in participating skilled nursing facilities (SNFs) and hospitals under circumstances in which they cannot be covered under hospital insurance (e.g., the services are not furnished by the participating institution either directly or under arrangements that provide for the institution to bill for the services).
Scope of the Portable X-ray Benefit
In order to avoid payment for services which are inadequate or hazardous to the patient, the scope of the covered portable X-ray benefit is defined as:
Exclusions from Coverage as Portable X-ray Services
Procedures and examinations which are not covered under the portable X-ray provision include the following:
The following HCPCS codes should be used as a guide when submitting claims for transportation and set up of portable X-ray equipment.
These codes represent the transportation of the equipment to the patient. The transportation charge is not payable unless the portable X-ray equipment used was actually transported to the location where the X-ray was taken. Suppliers should not bill for a transport fee when the X-ray equipment is stored in a facility for use as needed. If the X-ray is not covered, the transportation and set up will also be non-covered.
Providers may not submit claims for transport or set-up fees in conjunction with electrocardiograms (EKGs).
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Last Updated: 07/31/2020