[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR414.38]

[Page 628]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES--Table of Contents
 
              Subpart B--Physicians and Other Practitioners
 
Sec. 414.38  Special rules for payment of low osmolar contrast media.

    (a) General. Payment for low osmolar contrast media is included in 
the technical component payment for diagnostic procedures except as 
specified in paragraph (b) of this section.
    (b) Conditions for separate payment. For diagnostic procedures 
furnished to beneficiaries who are neither inpatients nor outpatients of 
any hospital, separate payment is made for low osmolar contrast media 
used in all intrathecal injections and in intravenous, and intra-
arterial injections, if it is used for patients with one or more of the 
following characteristics:
    (1) A history of a previous adverse reaction to contrast material, 
with the exception of a sensation of heat, flushing, or a single episode 
of nausea or vomiting.
    (2) A history of asthma or allergy.
    (3) Significant cardiac dysfunction including recent or imminent 
cardiac decompensation, severe arrhythmias, unstable angina pectoris, 
recent myocardial infarction, and pulmonary hypertension.
    (4) Generalized severe debilitation.
    (5) Sickle cell disease.
    (c) Method of payment. If one of the conditions of paragraph (b) of 
this section is met, payment is made for low osmolar contrast media as 
set forth in Sec. 414.36 as a drug furnished incident to a physician's 
service, subject to paragraph (d) of this section.
    (d) Drug payment reduction. If separate payment is made for low 
osmolar contrast media, the payment amount calculated in accordance with 
Sec. 414.36 is reduced by 8 percent to account for the allowance for 
contrast media already included in the technical component of the 
diagnostic procedure code.

[56 FR 59624, Nov. 25, 1991, as amended at 57 FR 42492, 42493, Sept. 15, 
1992]