Statutes, codes, and regulations
New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICESChapter II - Regulations of the Department of Social ServicesSubchapter E - Medical CareArticle 3 - Policies and Standards Governing Provision of Medical and Dental Care
Part 505 - Charges For Professional Health Services
Section 505.17 - Radiology services

N.Y. Comp. Codes R. & Regs. tit. 18 § 505.17

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Current through Register Vol. 46, No. 50, December 11, 2024
Section 505.17 - Radiology services
(a) Scope. This section describes the department's policies governing the provision of and payment for radiology services under the medical assistance (MA) program.
(b) Purpose. The MA program will pay for medically necessary radiology services provided by qualified practitioners as described in this section and in the settings authorized by this section.
(c) Definitions.
(1) Dentist means a dentist who is qualified in accordance with Part 506 of this Title.
(2) Physician nonspecialist means a physician who is qualified in accordance with section 505.2 of this Part.
(3) Physician specialist means a physician, other than a radiologist, who is qualified as a specialist in accordance with section 505.2 of this Part.
(4) Podiatrist means a podiatrist who is qualified in accordance with section 505.12 of this Part.
(5) Qualified practitioner means a radiologist, physician specialist, physician nonspecialist, dentist or podiatrist as defined in this section.
(6) Radiologist means a physician who is qualified as a specialist in radiology in accordance with section 505.2 of this Part.
(7) Radiology services means the provision of the following services to MA recipients:
(i) interventional radiology;
(ii) screening and diagnostic radiology, including ultrasound and nuclear medicine; or
(iii) radiation oncology.
(8) Mobile setting means those radiology services provided by a qualified practitioner which are not performed in the practitioner's office and includes those services which use portable equipment for the provision of radiology services.
(d) Who can provide radiology services. Radiology services can be provided only by the following qualified practitioners and with the following limitations:
(1) a radiologist;
(2) a physician specialist may provide radiology services related and limited to the physician's area of specialty;
(3) a physician nonspecialist may provide radiology services as medically necessary, but such services must be limited to routine diagnostic chest X-rays and/or diagnostic X-rays for acute injuries; and
(4) dentists and podiatrists may provide radiology services related and limited to their scope of practice.
(e) Where radiology services can be provided. Qualified practitioners, as defined in this section, may provide radiology services in their offices, in mobile settings or in facilities certified under article 28 of the Public Health Law. In each such instance the requirements of subdivision (f) of this section must be met.
(f) Limitations on payment for radiology services.
(1) In order to be paid for both the professional and the technical and administrative components of the radiology service or solely for the technical and administrative component, as defined in section 533.6(b) of this Title, qualified practitioners who provide radiology services in their offices must :
(i) own or directly lease the equipment and must supervise and control the radiology technicians who perform the radiology procedures; or
(ii) be the employees of physicians who own or directly lease the equipment and must supervise and control the radiology technicians who perform the radiology procedures.
(2) In order to be paid for both the professional and the technical and administrative components of the radiology services or solely for the technical and administrative component, as defined in section 533.6(b) of this Title, qualified practitioners who provide radiology services in mobile settings must :
(i) own or directly lease the equipment and must employ the radiology technicians who perform the radiology procedures; or
(ii) be the employees of physicians who own or directly lease the equipment and such physicians must employ the radiology technicians who perform the radiology procedures.
(3) A qualified practitioner who provides radiology services in a facility certified under Article 28 of the Public Health Law which owns or leases the equipment will be paid only the professional component of the radiology services as defined in section 533.6 of this Title. No payment will be made to a qualified practitioner solely for the technical and administrative component of radiology services provided in such a facility.
(4) If a qualified practitioner in private practice sends a film to a radiologist for professional review, the practitioner must comply with paragraph (1) or (2) of this subdivision and payment will be made solely for the technical and administrative component as defined in section 533.6 of this Title . The radiologist performing the read will be reimbursed solely for the professional component as defined in section 533.6 of this Title.
(g) Leasing of radiology equipment. Payments for leasing radiology equipment must be based on the reasonable costs of furnishing and maintaining the equipment leased, must not be based on a percentage of fees billed or received for radiology services, and must be in compliance with Federal and State law and regulations pertaining to kickbacks and other illegal payment or repayment arrangements.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 505.17

Amended New York State Register September 14, 2022/Volume XLIV, Issue 37, eff. 9/14/2022