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September 24, 2018

Portable X-Ray Benefit

As noted in the IOM, the portable x-ray benefit is specific on what is covered. CGS would like to clarify that ribs, facial bones, mandible, orbits, sinuses and neck soft tissue are NOT part of the defined portable x-ray coverage and will be denied.

The following is from the Internet Only Manual:

80.4.3 - Scope of Portable X-Ray Benefit
(Rev. 71, Issued: 05-25-07, Effective: N/A; Implementation: July 2, 2007)

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:

Skeletal films involving the extremities, pelvis, vertebral column, or skull;
Chest films which do not involve the use of contrast media (except routine screening procedures and tests in connection with routine physical examinations);
Abdominal films which do not involve the use of contrast media; and
Diagnostic mammograms if the approved portable x-ray supplier, as defined in 42 CFR part 486, subpart C, meets the certification requirements of section 354 of the Public Health Services Act, as implemented by 21 CFR part 900, subpart B.

80.4.4 - Exclusions From Coverage as Portable X-Ray Services
(Rev. 1, 10-01-03)
B3-2070.4.D

Procedures and examinations which are not covered under the portable x-ray provision include the following:

Procedures involving fluoroscopy;
Procedures involving the use of contrast media;
Procedures requiring the administration of a substance to the patient or injection of a substance into the patient and/or special manipulation of the patient;
Procedures which require special medical skill or knowledge possessed by a doctor of medicine or doctor of osteopathy or which require that medical judgment be exercised;
Procedures requiring special technical competency and/or special equipment or materials;
Routine screening procedures; and
Procedures which are not of a diagnostic nature.

Reference:

IOM 100-02 Medicare Benefit Policy Manual, Chapter 15 Covered Medical and Other health Services, sec 80.4.3

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

Portable X-Ray Benefit

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