Portable x-ray services can consist of the following:

• the professional component (that is, the professional interpretation of the x-ray study) which should be reported using the appropriate radiology procedure code;
• the technical component which may consist of up to 3 separate parts, all of which are covered under Medicare Advantage when furnished in a place or residence used as the patient's home and in nonparticipating institutions. These are:
  • the actual taking of the x-ray which should be reported using the appropriate radiology procedure code;
  • transportation of the portable x-ray equipment (codes R0070, R0075);
  • set-up of the equipment (code Q0092). 

Diagnostic x-ray services performed by a portable x-ray supplier
Diagnostic x-ray services furnished by a portable x-ray supplier are covered under Medicare Advantage when furnished in a place or residence used as the patient’s home and in nonparticipating institutions.

These services must be performed under the general supervision of a physician, the supplier must meet FDA certification requirements, and certain conditions relating to health and safety (as prescribed by the Secretary) must be met.

Diagnostic portable x-ray services are also covered when provided in participating skilled nursing facilities and hospitals, under circumstances in which they cannot be covered under hospital insurance, i.e., the services are not furnished by the participating institution either directly or under arrangements that provide for the institution to bill for the services.

Transportation of x-ray equipment by a portable x-ray supplier
Payment can be made for only one transportation charge for each trip the portable x-ray supplier makes to a particular location. When more than one Medicare Advantage patient is x-rayed at the same location, e.g., a nursing home, prorate the single fee schedule transportation payment among all patients receiving the services.

Set-up of x-ray equipment by a portable x-ray supplier
Payment may be made for a set-up component (code Q0092) for each radiologic procedure (other than retakes of the same procedure) during both single patient and multiple patient trips. 

Covered diagnostic imaging services performed by portable x-ray suppliers
Covered portable x-ray benefits include the following: 

• Skeletal films involving the extremities, pelvis, vertebral column, or skull;
• Chest films which do not involve the use of contrast media (except routine screening procedures and tests in connection with routine physical examinations);
• Abdominal films which do not involve the use of contrast media; and
• Diagnostic mammograms if the approved portable x-ray supplier, as defined in 42 CFR part 486, subpart C, meets the certification requirements of section 354 of the Public Health Services Act, as implemented by 21 CFR part 900, subpart B.

Portable hand held x-ray instrument (NCD 220.10)
Medicare Advantage covers the use of the portable hand-held x-ray instrument as an imaging device. However, this service is considered part of a physician’s professional service. No additional charge for this service is separately reimbursable. This low intensity x-ray imaging device is a light weight portable hand-held instrument using a low level energy source to view any part of the human anatomy that can be inserted in the space between the energy source and the viewing mechanism. The device can be useful in making an immediate diagnosis in the following circumstances: isolated areas, accident scenes, sporting events and emergency rooms. It is also useful in the following instances where fluoroscopy would ordinarily be used: localization of foreign bodies, selected surgical procedures and the evaluation of premature or low birth weight infants. 

Ineligible services performed by a portable x-ray supplier
Procedures and examinations which are not covered under the portable x-ray provision include the following:

• Procedures involving fluoroscopy;
• Procedures involving the use of contrast media;
• 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;
• Procedures which require special medical skill or knowledge possessed by a doctor of medicine or doctor of osteopathy or which require that medical judgment be exercised;
• Procedures requiring special technical competency and/or special equipment or materials;
• Routine screening procedures; and
• Procedures which are not of a diagnostic nature.

Diagnostic ECG services performed by a portable x-ray supplier
The taking of an electrocardiogram tracing by an approved supplier of portable x-ray services may be covered as an “other diagnostic test.” The appropriate health and safety standards apply to diagnostic EKG services, for example, the technician must meet the personnel qualification requirements in the conditions for coverage of portable x-ray services. 

Transportation of ECG equipment by a portable x-ray supplier
A separate payment is not made for the transportation of ECG equipment (code R0076) by portable x-ray suppliers or any other entity. 

Set-up of ECG equipment by a portable x-ray supplier
No payment can be made for the set-up for ECG services furnished by the portable x-ray supplier.

Documentation Requirements

The service must be provided on the written order of a physician. The name of the ordering physician must be documented on the claim. 

The clinical reason, diagnosis, or condition for the x-ray performed must be documented. 

Payment is made only for services performed by CMS-approved suppliers of portable x-ray services. Notice of the coverage dates for services of approved portable x-ray suppliers is provided by the CMS Regional Office. 

Report transportation services (codes R0070, R0075) in conjunction with the CPT radiology codes (70000 series) and only when the x-ray equipment used was actually transported to the location where the x-ray was taken. 

Do not report a transportation service when the x-ray equipment is stored in the location where the x-ray was done (e.g., a nursing home) for use as needed.

If only one patient is imaged, code R0070 should be reported with no modifier since the descriptor for this code reflects only one patient seen. However, one of the following modifiers should be reported with code R0075. Only one of these five modifiers should be reported with R0075. If only one patient is imaged, code R0070 should be reported with no modifier since the descriptor for this code reflects only one patient seen.

• UN - Two patients served
• UP - Three patients served
• UQ - Four patients served
• UR - Five Patients served
• US - Six or more patients served

Provider News

08/2011, Services performed with a portable hand held x-ray instrument not reimbursed separately

CMS Online Manual Pub. 100-02, Chapter 15, Section 80.4

CMS Online Manual Pub. 100-4, Chapter 13, Section 90

CMS Online Manual Pub. 100-02, Chapter 1, Section 220.10