All HMO members and most POS members using their referred benefit are required to obtain outpatient diagnostic radiology services at their primary care physician’s capitated radiology site.
However, in some acute circumstances, medically necessary X-rays associated with a fracture may be performed in a specialist’s office. Hand surgeons, orthopedic surgeons, podiatrists, and sports medicine specialists are eligible for fee-for-service reimbursement consideration for X-rays associated with a fracture that are performed in the office setting.
Claim Payment Policy #00.03.09: X-rays Associated with Fractures in the Office Setting became available in May for providers and their office staff. The noted specialists should read this policy in its entirety.