N.Y. Comp. Codes R. & Regs. tit. 18 § 533.6
Current through Register Vol. 46, No. 43, October 23, 2024
Section 533.6 - Radiology(b) Radiology fee components. The fees listed in each Radiology Fee Schedule set forth in subdivision (a) of this section include payment for the professional component and/or the technical and administrative component of radiology services. (1) Professional component. The professional component of radiology services refers to the various professional services performed by physicians, including: (i)(a) for interventional radiology services, determining the patient's problem, including interviewing the patient, obtaining the patient's medical history, and examining the patient to decide how to perform radiology procedures;(b) for diagnostic radiology services, reviewing relevant clinical information as presented by the ordering or referring physician, including the basis for performing the radiology study;(ii) studying the results of diagnostic or therapeutic procedures, interpreting X-rays or radioisotope data and estimating treatment results;(iii) dictating examination or treatment reports; and(iv) consulting with and furnishing written reports to referring physicians regarding the results of diagnostic or therapeutic procedures.(2) Technical and administrative component of radiology services. The technical and administrative component of radiology services refers to various services, including the following: (i) use of personnel, such as technologists and clerical staff;(ii) use of supplies such as film, opaques, radioactive substances, chemicals and drugs; and(iii) purchase, rental or maintenance of space, equipment, telephones or other related supplies.(3) Procedures not separable into professional and technical and administrative components. Injections of radiopaque media, fluoroscopy and consultations must be performed by the physician. Consequently, these procedures are not separated for billing into professional and technical and administrative components, and the total fee listed in the relevant Radiology Fee Schedule set forth in subdivision (a) of this section for such services is paid to the physician.(c) Reimbursement. (1) Physicians who render both the professional and technical and administrative components of a radiology service must meet the requirements of section 505.17 of this Title and will be reimbursed the global fee listed in the relevant Radiology Fee Schedule set forth in subdivision (a) of this section.(2) Physicians who render solely the professional component of a radiology service will be reimbursed the professional fee listed in the relevant Radiology Fee Schedule set forth in subdivision (a) of this section.(3) Physicians who render solely the technical and administrative component of a radiology service must meet the requirements in section 505.17 of this Title and will be reimbursed the technical and administrative fee listed in the relevant Radiology Fee Schedule set forth in subdivision (a) of this section.(4) Hospitals that render both the professional and technical component of a radiology service will be reimbursed the global fee listed in the relevant Radiology Fee Schedule set forth in subdivision (a) of this section.(5) Hospitals that render solely the technical and administrative component of a radiology service will be reimbursed the technical and administrative fee listed in the relevant Radiology Fee Schedule set forth in subdivision (a) of this section.(d) General rules. These rules apply to all procedure codes found in the Radiology Fee Schedule. (1) What is included in radiology fees. Fees listed in the Radiology Fee Schedule include the following: (i) the usual contrast media, equipment and materials. When the physician supplies special surgical trays or materials, an additional charge may be claimed from the department;(ii) consultation with and written reports provided to the referring physician; and(iii) payment for injection procedures, such as local anesthesia, needle or catheter placement or injection of contrast media as provided in the Radiology Fee Schedule, except for injection procedures which are identified by an asterisk before the code in the Radiology Fee Schedule.(2) Payment for multiple or repeat radiology procedures. (i) When more than one radiology procedure is performed on different parts of the body during the same visit, the total payment is the sum of the fee for the more costly procedure plus 60 percent of the fee for the less costly procedure.(ii) When a single radiology procedure is performed which shows more than one part of the body, payment will be made for only one procedure.(iii) When repeat radiology procedures are performed on the same part of the body and for the same illness, payment for the repeat procedures will be made according to the fee listed in the Radiology Fee Schedule. However, no payment will be made for repeat procedures on the same part of the body and for the same illness when the reason for the repeat procedure is technical or professional error in the original procedure.(e) Outpatient and clinic services. No additional payment will be made for outpatient emergency and clinic services if the cost of providing radiology or radiotherapy services is included in the maximum reimbursement rate promulgated for the hospital by the Director of the Budget pursuant to section 2807 of the Public Health Law. When physicians refer patients for outpatient radiology or radiotherapy services, payment will be made according to the Radiology Fee Schedule except when radiology or radiotherapy services are provided in a facility that includes the cost of these services in its clinic rate calculation. In these cases, the recipient shall be registered as a clinic patient and the clinic rate shall be billed.(f) Current Procedural Terminology ( CPT) code modifiers. Each radiology procedure listed in the Radiology Fee Schedule s set forth in subdivision (a) of this section is preceded by a five-digit number identifying the specific procedure for which payment is claimed. Known as a CPT procedure code, this number sometimes must be expanded by two additional digits, or modifiers, to describe more completely the particular procedure involved. The modifiers used in radiology are are found in the relevant Radiology Fee Schedule set forth in subdivision (a) of this section.N.Y. Comp. Codes R. & Regs. Tit. 18 § 533.6
Amended New York State Register September 14, 2022/Volume XLIV, Issue 37, eff. 9/14/2022