PDFWAC 182-531-1450

Radiology physician-related services.

(1) The medicaid agency reimburses radiology services subject to the limitations in this section and under WAC 182-531-0300.
(2) The agency does not make separate payments for contrast material. The exception is low osmolar contrast media (LOCM) used in intrathecal, intravenous, and intra-arterial injections. Clients receiving these injections must have one or more of the following conditions:
(a) A history of previous adverse reaction to contrast material. An adverse reaction does not include a sensation of heat, flushing, or a single episode of nausea or vomiting;
(b) A history of asthma or allergy;
(c) Significant cardiac dysfunction including recent or imminent cardiac decompensation, severe arrhythmias, unstable angina pectoris, recent myocardial infarction, and pulmonary hypertension;
(d) Generalized severe debilitation;
(e) Sickle cell disease;
(f) Preexisting renal insufficiency; and/or
(g) Other clinical situations where use of any media except LOCM would constitute a danger to the health of the client.
(3) The agency reimburses separately for radiopharmaceutical diagnostic imaging agents for nuclear medicine procedures. Providers must submit invoices for these procedures when requested by the agency, and reimbursement is at actual acquisition cost.
(4) The agency reimburses general anesthesia for radiology procedures. See WAC 182-531-0300.
(5) The agency reimburses radiology procedures in combination with other procedures according to the rules for multiple surgeries. See WAC 182-531-1700. The procedures must meet all of the following conditions:
(a) Performed on the same day;
(b) Performed on the same client; and
(c) Performed by the same physician or more than one member of the same group practice.
(6) The agency reimburses consultation on X-ray examinations. The consulting physician must bill the specific radiological X-ray code with the appropriate professional component modifier.
(7) The agency reimburses for portable X-ray services furnished in the client's home or in nursing facilities, limited to the following:
(a) Chest or abdominal films that do not involve the use of contrast media;
(b) Diagnostic mammograms; and
(c) Skeletal films involving extremities, pelvis, vertebral column, or skull.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 24-08-061, § 182-531-1450, filed 3/29/24, effective 5/1/24; WSR 17-04-039, § 182-531-1450, filed 1/25/17, effective 2/25/17. WSR 11-14-075, recodified as § 182-531-1450, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 10-19-057, § 388-531-1450, filed 9/14/10, effective 10/15/10. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 01-01-012, § 388-531-1450, filed 12/6/00, effective 1/6/01.]