[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR415.120]



[Page 797]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 415_SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING 

PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS

--Table of Contents

 

      Subpart C_Part B Carrier Payments for Physician Services to 

                       Beneficiaries in Providers

 

Sec. 415.120  Conditions for payment: Radiology services.



    (a) Services to beneficiaries. The carrier pays for radiology 

services furnished by a physician to a beneficiary on a fee schedule 

basis only if the services meet the conditions for fee schedule payment 

in Sec. 415.102(a) and are identifiable, direct, and discrete 

diagnostic or therapeutic services furnished to an individual 

beneficiary, such as interpretation of x-ray plates, angiograms, 

myelograms, pyelograms, or ultrasound procedures. The carrier pays for 

interpretations only if there is a written report prepared for inclusion 

in the patient's medical record maintained by the hospital.

    (b) Services to providers. The carrier does not pay on a fee 

schedule basis for physician services to the provider (for example, 

administrative or supervisory services) or for provider services needed 

to produce the x-ray films or other items that are interpreted by the 

radiologist. However, the intermediary pays the provider for these 

services in accordance with Sec. 415.55 for provider costs; Sec. 

415.102(d)(2) for costs incurred by a physician, such as under a lease 

or concession agreement; or part 412 of this chapter for payment under 

PPS.