55 Pa. Code § 1150.57. Diagnostic services and radiation therapy.

§ 1150.57. Diagnostic services and radiation therapy.

(a)  The fees for diagnostic radiology, nuclear medicine, radiation therapy, pathology and medical diagnostic procedures are comprised of a total fee, which is divided into a professional component fee and a technical component fee.
(b)  The technical component of any diagnostic services provided on an inpatient basis will be included in the hospitals’ payment for inpatient services. No other payment will be made for the total component or technical component for inpatient services.
(c)  Physicians may bill for a visit in addition to the professional component if an appropriate medical care visit is provided. However, a visit to a practitioner’s office or the outpatient department of a hospital solely for the purpose of receiving a diagnostic service or radiation therapy does not qualify for payment for a visit and the diagnostic service or radiation therapy. In this kind of situation, payment is made only for the diagnostic service or radiation therapy.
(d)  A practitioner may bill for laboratory services performed in the office only if the practitioner is licensed by the Department of Health and enrolled in the MA Program as a laboratory.
(e)  A practitioner may bill for medical diagnostic, surgical diagnostic, diagnostic radiology, nuclear medicine and radiation therapy in addition to:
   (1)  A surgical procedure.
   (2)  A medical care visit if the situation described in subsection (c) does not occur.

Authority

   The provisions of this §  1150.57 amended under sections 201(2), 403 and 443.3 of the Public Welfare Code (62 P.S. § §  201(2), 403 and 443.3).

Source

   The provisions of this §  1150.57 adopted January 7, 1983, effective January 1, 1983, 13 Pa.B. 305; amended September 7, 1984, effective July 1, 1984, 14 Pa.B. 3252; amended September 5, 2008, effective September 6, 2008, 38 Pa.B. 4898. Immediately preceding text appears at serial page (251216).

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