Radiology Services: Service Limitations

(A) Definitions. Global Fee. The rate of payment for the two components of a radiology service: the professional component and the technical component. Professional Component. The component of a radiology service for interpreting a diagnostic test or image. Technical Component. The component of a radiology service for the cost of rent, equipment, utilities, supplies, administrative and technical salaries and benefits, and other overhead expenses. (B) Payment of the Global Fee. The MassHealth agency will pay a CHC the global fee for performing a radiology service at the CHC when one of the following conditions is met. (1) The CHC owns or leases the equipment for providing the technical component of the service, employs a technician to provide the technical component of the service, and employs a board-certified or board-eligible radiologist to provide the professional component of the service. (2) The CHC employs a board-certified or board-eligible radiologist to provide the professional component of the service and the CHC subcontracts with a licensed Medicare-certified entity to provide the technical component of the service. (3) The CHC subcontracts with a licensed Medicare-certified entity to provide the professional and technical component of the service. (C) Subcontracting for Radiology Services. (1) All subcontracts between the CHC and the licensed Medicare-certified entity must be in writing, ensure continuity of care, and be consistent with all applicable provisions of 130 CMR 405.000. (2) The CHC is legally responsible to the MassHealth agency for the performance of any subcontractor. The CHC must ensure that every subcontractor is licensed and Medicare-certified, and that services are furnished in accordance with the MassHealth agency’s regulations, including, but not limited to, those set forth in 130 CMR 450.000. The CHC must submit claims for payment for radiology services provided hereunder in accordance with the MassHealth agency’s regulations and applicable fee schedules. (D) Radiology Recordkeeping (Medical Records) Requirements. In addition to complying with the general recordkeeping requirements (see 130 CMR 405.412), the CHC must keep records of radiology services performed. All X-rays must be labeled with the following: (1) the member’s name; (2) the date of the examination; (3) the nature of the examination; and (4) left and right designations and patient position, if not standard.