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 UCC the global fee for performing a radiology service at the UCC when one of the following conditions is met. (1) The UCC 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 UCC employs a board-certified or board-eligible radiologist to provide the professional component of the service and the UCC subcontracts with a licensed Medicare- certified entity to provide the technical component of the service. (3) The UCC 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 UCC and the licensed Medicare-certified entity must be in writing, ensure continuity of care, and be consistent with all applicable provisions of 130 CMR 455.000. (2) The UCC is legally responsible to the MassHealth agency for the performance of any subcontractor. The UCC 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: Administrative and Billing Regulations. The UCC 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 455.422), the UCC 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.