1. (a) Portable X-ray procedures billed to the Department shall be based on a practitioner’s written request. The written request must include:

   1. (1) The practitioner’s name and medical license number.
   2. (2) The recipient’s name and address.
   3. (3) The recipient’s case number.
   4. (4) The date of the request.
   5. (5) The handwritten signature of the practitioner or the practitioner’s designated employe.
   6. (6) The number and type of X-ray studies requested.
   7. (7) The diagnosis or reason the X-rays were ordered.
   8. (8) The reasons for the need for portable X-ray study rather than office X-ray.
2. (b) Payment for transporting portable X-ray equipment from the provider’s office to the place of service will be made in accordance with Chapter 1150 (relating to MA Program payment policies) and the MA Program fee schedule and the limitation in § 1230.53 (relating to limitation on payment).

Source

The provisions of this § 1230.52 adopted August 13, 1982, effective August 14, 1982, 12 Pa.B. 2688; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932; amended September 30, 1988, effective October 1, 1988, 18 Pa.B. 4418. Immediately preceding text appears at serial page (117498).

Cross References

This section cited in 55 Pa. Code § 1230.52a (relating to clarification of the terms ‘‘written’’ and ‘‘signature’’—statement of policy).