1. A. General policies for payment that are applicable to all providers are set forth in COMAR 10.09.36.04.
2. B. The Department shall allow a single transportation payment for each trip the portable X-ray provider makes to a particular location.

3. C. The Department shall reimburse for covered services at the lesser of:

   1. (1) The provider’s customary charge unless the service is free to individuals not covered by Medicaid; or
   2. (2) The Department’s fee schedule.
4. D. The Department’s fee-schedule is contained in COMAR 10.09.02.07D.

5. E. Payments on Medicare cross-over claims are authorized if :

   1. (1) The provider accepts Medicare assignment;
   2. (2) Medicare makes direct payment to the provider;
   3. (3) Medicare has determined that the services are medically necessary;
   4. (4) The services are covered by the program; and
   5. (5) The initial billing is made directly to Medicare according to Medicare guidelines.

6. F. The Department shall make supplemental payment on Medicare claims subject to the following provisions:

   1. (1) Coinsurance shall be paid at the lesser of:

      1. (a) 100 percent of the coinsurance amount; or
      2. (b) The balance remaining after the Medicare payment is subtracted from the Medicaid rate.
7. G. The Program may not make a direct payment to a recipient.
8. H. Billing time limitations are those set forth in COMAR 10.09.36.06.

9. I. The provider may not bill the Program or recipient for:

   1. (1) Completion of forms and reports;
   2. (2) Broken or missed appointments;
   3. (3) Services rendered by mail or telephone; and
   4. (4) Providing a copy of a recipient’s medical record when requested by another licensed provider on behalf of the recipient.
10. J. The portable X-ray provider shall identify the individual who ordered the portable X-ray services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim.

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

Effective date: April 28, 2014 (41:8 Md. R. 472)

Regulation .04A amended effective January 1, 2018 (44:26 Md. R. 1214)

Regulation .05A amended effective January 1, 2018 (44:26 Md. R. 1214)

Regulation .05K adopted effective January 1, 2018 (44:26 Md. R. 1214)

Regulation .07C, I amended effective July 4, 2016 (43:13 Md. R. 712)

Regulation .07D amended effective February 27, 2017 (44:4 Md. R. 252)

Regulation .07J adopted effective January 1, 2018 (44:26 Md. R. 1214)