Cal. Code Regs. Tit. 22, § 51311 - Laboratory, Radiological, and Portable Imaging Services
(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.
(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.
(c)
Procedures and examinations that are not covered as portable imaging services
include:
(1) Procedures involving
fluoroscopy;
(2) Procedures
involving the use of contrast media;
(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) Procedures that require special medical
skill or knowledge possessed by a physician, dentist or podiatrist or that
require that medical judgment be exercised;
(5) Routine screening procedures;
(6) Procedures that are not of a diagnostic
nature; and
(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:
(A) Immobilization of the
patient.
(B) Avoidance of excessive
radiation due to the number of views required.
(C) Special techniques to deal with complex
radiologic problems.
(D) Special
equipment and supplies.
(d) Portable imaging services are covered
only when:
(1) The provider ordering the
portable imaging services has no financial interest in the business of the
portable imaging services provider; and
(2) The patient is under the direct care of
the ordering provider, not the portable imaging services
provider.
Notes
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).
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.
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
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