TN 2 (11-22)

HI 00610.120 Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests

Diagnostic x-ray, laboratory, and other diagnostic tests, including materials and the services of technicians are covered. Some examples of other diagnostic tests are basal metabolism readings, electro-encephalograms, electrocardiograms, respiratory function tests, cardiac evaluations, allergy tests, psychological tests, and otologic evaluations. In the case of diagnostic x-ray services and other diagnostic tests, payment may be made (for exceptions, see HI 00610.140-HI 00610.160 below) only if the services are furnished by a physician (or as incident to a physician's services).

An X-ray facility which is owned and directed by a physician or group of physicians is considered a physician's office and the services performed are covered if the necessary supervision requirements are met. Supervision and direction of the X-ray facility may be provided by one or more of the physician-owners or by another physician who has been engaged by the physician-owner for this purpose. While an independent laboratory is by definition independent of a physician's office, X-ray tests performed in a facility which is both owned by a physician and under physician supervision may be considered to have been performed in a physician's office; i.e., the clinical laboratory and X-ray areas of the facility may be considered for coverage purposes as separate entities.

Certain diagnostic X-ray procedures performed by technicians in a physician's office without direct personal physician supervision are covered if the technicians are employees of the physician and their general supervision and training as well as the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician-owner or of the physician engaged by the physician owner. Such procedures include skeletal films involving the extremities, pelvis, vertebral column or skull and chest or abdominal films which do not involve the use of contrast media. All therapeutic X-ray procedures, however, require the immediate personal supervision of a physician. (Even if the services of the technician are not covered because the above requirements are not met, payment could still be made for the charge of the radiologist for interpreting the X-ray.) For the X-ray procedure to be covered, the charge must also be included in a physician's or physician-directed clinic's bill. See HI 00610.160 for coverage of portable X-ray services.