Coverage Information for Portable X-Ray Suppliers (Specialty 63)
The Medical Policy Staff at Wisconsin Physicians Service (WPS) Medicare, recently reviewed information published by the Centers for Medicare & Medicaid Services (CMS), and made changes within our internal processing guidelines to comply with CMS instructions for Portable X-Ray services. Due to these changes, Portable X-Ray Suppliers may see denials for services previously considered for payment.
If you are a Portable X-Ray Supplier, you should refer to the CMS Website for coverage information for Portable X-ray Services. Coverage information is located in the Internet-Only Manual (IOM), Pub. 100-2 (Benefit Policy Manual,) Chapter 15, Sections 80.4.3 (inclusions) and Section 80.4.4 (exclusions). (pdf - 193 pages; 1MB)
Sections 80.4.3 and 80.4.4 of the IOM follow:
80.4.3 - Scope of 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:
- Skeletal films involving arms and legs, pelvis, vertebral column, and skull;
- Chest films which do not involve the use of contrast media (except routine screening procedures and tests in connection with routine physical examinations); and
- Abdominal films which do not involve the use of contrast media.
80.4.4 - Exclusions from Coverage as Portable X-Ray Services
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.
