Radiology Services: Payment Limitations

(A) The maximum allowable fees include payment for both the technical and professional components of the radiology service. A CHC must not bill for either the professional or technical component separately. (B) Radiology services that are not listed in Subchapter 6 of the Community Health Center Manual are not reimbursable when furnished in a CHC. The CHC should refer a member to a hospital for such services. (C) Some services listed in Subchapter 6 of the Community Health Center Manual are designated “SP”, an abbreviation for separate procedure. Radiology services that are performed at separate sittings on the same or different days are considered separate procedures. The CHC must not bill separately for a service listed as an SP service when this service is furnished as a portion of another radiology service at the same sitting. (D) A CHC must not bill for a visit when a member is being seen for a radiology service only. (130 CMR 405.444 through 405.450 Reserved)