Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › RADIOLOGY › Section 20-2-II - GUIDELINES

Current through June 25, 2024
A.
Total Fee.
A total fee
				includes both the professional component for the radiologist and the technical
				component needed to accomplish the procedure. Explanations of the professional
				component and the technical component are listed below. The values as listed in
				the MAR column represent the total reimbursement.
B.
Professional Component.
The
				professional component represents the reimbursement allowance of the
				professional radiological services of the physician and is identified by the
				use of modifier 26. This includes examination of the patient when indicated,
				performance or supervision of the procedure, interpretation and written report
				of the examination, and consultation with the referring physician. In the
				majority of hospital radiology departments, the radiologist submits a separate
				statement to the patient for professional services rendered, which are listed
				as the professional component. Values in the PC Amount column are intended for
				the services of a radiologist for the professional component only and do not
				include any other charges. To identify a charge for a professional component
				only, use the five-digit code followed by modifier 26.
C.
Technical Component.
The
				technical component includes charges made by the institution or clinic to cover
				the services of technologists and other staff members, the film, contrast
				media, chemicals and other materials, and the use of the space and facilities
				of the x-ray department. To identify a charge for a technical component only,
				use the five-digit code followed by HCPCS modifier TC. The technical component
				amount is listed in the TC Amount column of the Fee Schedule.
D.
Review of X-rays.
Billing
				code 76140 is not appropriate in the following circumstances because review of
				the x-rays is inherent to the evaluation and management code:
* The physician, during the course of an office visit or
				  consultation, reviews an x-ray made elsewhere; . The treating or consulting
				  physician reviews x-rays at an emergency room or hospital visit;
* CPT code 76140, Consultation on x-ray examination made
				  elsewhere, written report, will only be paid when there is a documented need
				  for the service and when performed by a radiologist or physician certified to
				  perform radiological services;
* This provision is for payment of a second interpretation
				  under unusual circumstances such as a questionable finding for which the
				  physician performing the initial interpretation requests the expertise of
				  another physician (i.e., expertise of a radiologist). CPT code 76140 is to be
				  used when a second opinion is required for a radiological procedure.
				  Reimbursement is limited to the PC Amount listed in the Fee Schedule for the
				  radiological procedure.
E.
Additional X-rays.
No payment shall be made for additional x-rays
				when recent x-rays are available except when supported by adequate information
				regarding the need to retake x-rays. The use of photographic or digital media
				and/or imaging is not reported separately, but is considered to be a component
				of the basic procedure and shall not merit any additional payment.
F.
Comparison X-rays.
Comparison
				x-rays are reimbursable when appropriate. Any repeat comparison x-ray requires
				prior approval and will not be reimbursed without prior approval.
G.
Contrast Material
1. Complete procedures, interventional
				radiological procedures, or diagnostic studies involving injection of contrast
				media include all usual pre-injection and post-injection services (e.g.,
				necessary local anesthesia, placement of needle catheter, injection of contrast
				media, supervision of the study, and interpretation of results).
2. Low osmolar contrast material and
				paramagnetic contrast materials shall only be billed when not included in the
				descriptor of the procedure. When appropriately billed, the contrast media is
				reimbursed according to the lesser of the billed charges or MAR listed in the
				HCPCS section of the Fee Schedule. Supplies are considered incidental to the
				administration of the contrast and are not separately reimbursable.
3. When contrast can be administered orally
				(upper G.I.) or rectally (barium enema), the administration of contrast is
				included as part of the procedure and not separately reimbursed.
4. When an intravenous line is placed simply
				for access in the event of a problem with a procedure or for administration of
				contrast, it is considered part of the procedure and is not separately
				reimbursed.