1. (a) Examinations, tests, and therapeutic services ordered by a licensed practitioner, within his/her scope of practice as defined by California law, for the purpose of providing information for the diagnosis, prevention, or treatment of any disease, injury or impairment of, or the assessment of the health of, human beings, or used as an aid in the prevention, prognosis, monitoring, or treatment of a physiological or pathological condition or illness in a human being are covered except that laboratory services provided for chronic outpatient hemodialysis in renal dialysis centers and community hemodialysis units are payable only when billed by the renal dialysis center or community hemodialysis unit.
2. (b) Portable imaging services are covered subject to prior authorization except when they are rendered in skilled nursing and intermediate care facilities. Emergency portable imaging services performed in locations other than skilled nursing and intermediate care facilities do not require prior authorization.

3. (c) Procedures and examinations that are not covered as portable imaging services include:

   1. (1) Procedures involving fluoroscopy;
   2. (2) Procedures involving the use of contrast media;
   3. (3) Procedures requiring the administration of a substance to the patient or injection of a substance into the patient and/or special manipulation of the patient;
   4. (4) Procedures that require special medical skill or knowledge possessed by a physician, dentist or podiatrist or that require that medical judgment be exercised;
   5. (5) Routine screening procedures;
   6. (6) Procedures that are not of a diagnostic nature; and

   7. (7) Procedures that for safety, and effectiveness to permit clear interpretation of the image by a radiologist, need to be performed in a radiology facility; and require any of the following:

      1. (A) Immobilization of the patient.
      2. (B) Avoidance of excessive radiation due to the number of views required.
      3. (C) Special techniques to deal with complex radiologic problems.
      4. (D) Special equipment and supplies.

4. (d) Portable imaging services are covered only when:

   1. (1) The provider ordering the portable imaging services has no financial interest in the business of the portable imaging services provider; and
   2. (2) The patient is under the direct care of the ordering provider, not the portable imaging services provider.

Note: Authority cited: Section 20, Health and Safety Code; and Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Section 1206, Business and Professions Code; Sections 14132, 14133, 14133.05 and 14133.1, Welfare and Institutions Code; and Section 149.1, Chapter 323, Statutes of 1993.

History

1. Amendment of subsection (b) and new subsection (c)(7) filed 12-30-83 as an emergency; effective upon filing (Register 84, No. 1). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 4-29-84. For prior history, see Register 83, No. 6.

2. New subsection (c)(7) refiled 4-23-84 as an emergency; designated effective 4-30-84 (Register 84, No. 21). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 8-21-84.

3. Certificate of Compliance as to 12-30-83 order (subsection (b) only) transmitted to OAL 4-27-84 and filed 5-22-84 (Register 84, No. 21).

4. Amendment of subsection (b) filed 5-22-84; effective thirtieth day thereafter (Register 84, No. 21).

5. Certificate of Compliance as to 4-23-84 order transmitted to OAL 8-15-84 and filed 9-12-84 (Register 84, No. 37).

6. Amendment of subsection (c)(7) filed 9-12-84; effective upon filing pursuant to Government Code Section 11346.2(d) (Register 84, No. 37).

7. Amendment of subsection (a) and Note filed 8-28-97 as an emergency; operative 8-28-97 (Register 97, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-26-97 or emergency language will be repealed by operation of law on the following day.

8. Editorial correction of Note (Register 98, No. 7).

9. Certificate of Compliance as to 8-28-98 order transmitted to OAL 12-24-97 and filed 2-9-98 (Register 98, No. 7).

10. Amendment of section and Note filed 5-12-2015; operative 7-1-2015 (Register 2015, No. 20).