New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter A - Medical Facilities-minimum Standards › Article 8 - New York State Annual Hospital Report › Part 447 - Standard Unit Of Measure References › Section 447.2 - Radiology services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) 
(a) ACCOUNT NUMBER     COST CENTER TITLE  
7320                Radiology--Diagnostic 
7360                Radiology--Therapeutic
7380                Nuclear Medicine
(b) The above
					 cost centers use as the basis for the Standard Unit of Measure the Radiology
					 Relative Values as determined by the California Medical Association, 1974
					 California Relative Value Studies (RVS). Relative Value Units for unlisted BR
					 (By Report), and RNE (Relativity Not Established) procedures are to be
					 reasonably estimated on the basis of other comparable procedures or estimated
					 by qualified personnel. Use the "Total Unit Value", not the "PC Unit Value", in
					 recording the relative value unit counts. Because the California Medical
					 Association is no longer publishing their Relative Value Studies booklet, the
					 Radiology/Nuclear Medicine chapter is set forth as subdivisions (c)-(g) of this
					 section with the approval of CMA.
(c) RADIOLOGY AND NUCLEAR MEDICINE GROUND
					 RULES
(1) GENERAL: Listed values for
					 radiology procedures apply only when these services are performed by or under
					 the supervision of a physician.
(i) The total
					 unit value includes the professional component (see PC unit value below) plus
					 the technical component. The value for injection procedure is not included
					 except when procedure is marked with a small star (). (See ground rule 6,
					 below). This value is applicable in any situation in which a single charge is
					 made to include both professional services and the technical cost of providing
					 that service. Identification of a procedure by its 5-digit code without
					 modifier -26 or -27 indicates that the charge includes both the "professional"
					 and "technical" components.
(ii)
					 The PC unit value (professional component unit value) represents the value of
					 the professional radiological services of the physician. This includes
					 examination of the patient, when indicated, performance and/or supevision of
					 the procedure, interpretation and written report of the examination and
					 consultation with the referring physician. The value for injection procedure is
					 not included except when procedure is marked with a small star (). (See ground
					 rule 6, below). This component is applicable in any situation in which the
					 physician submits a charge for these professional services only. It does not
					 include the cost of personnel, materials, space, equipment or other facilities.
					 To identify a charge for professional component, use the 5-digit procedure code
					 followed by modifier -26. (See modifier -26 and Appendix 1[FN[DOUBLE DAGGER]]
					 for use of modifiers.)
(iii) When
					 this section of the RVS is used in connection with a "conversion factor" to
					 establish fees, it must be emphasized that the SAME conversion factor cannot be
					 applied to both the TOTAL UNIT VALUE and the PROFESSIONAL COMPONENT UNIT VALUE.
					 Physicians who determine their fees by application of conversion factors to the
					 unit values in this section must determine a separate factor for TOTAL UNIT
					 VALUE and for PC UNIT VALUE.
(iv)
					 The technical component includes the charges for personnel, materials,
					 including usual contrast media and drugs, film or xerograph, space, equipment
					 and other facility but excludes the cost of radioisotopes. No unit values are
					 listed for the technical component of radiology procedures, since these are
					 institutional charges not billed separately by physicians. To identify a charge
					 for the technical component, use the 5-digit procedure code followed by
					 modifier -27. (See modifier -27 and Appendix 1 [FN[DOUBLE DAGGER]] for use of
					 modifiers.)