Chapter 4.5. Division of Workers' Compensation
SUBCHAPTER 1. ADMINISTRATIVE DIRECTOR -ADMINISTRATIVE RULES
Article 5.3. Official Medical Fee Schedule

§9789.17.2. Radiology Consultations.

(a)(1) Only one interpretation of an x-ray procedure shall be reimbursed. This interpretation of an x-ray procedure must directly contribute to the diagnosis and treatment of the patient. The physician must prepare a signed written report of his or her interpretation of the results of the x-ray. The professional component of the x-ray procedure shall be paid using modifier -26. A professional component billing based on a review of the findings of these x-ray procedures, without a complete written report similar to that which would be prepared by a specialist in the field, does not meet the conditions for separate payment of the service.

(2) Reimbursement for a second interpretation shall only be allowed under unusual circumstances (for which documentation is provided), such as a questionable finding for which the physician performing the initial interpretation believes another physician's expertise is needed or a changed diagnosis resulting from a second interpretation of the results of the procedure. This second interpretation shall be identified through the use of modifier “-77”.

(b) Do not use CPT 76140 (consultation on X-ray examination made elsewhere, written report).

Note: Authority: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 5307.1 and 5307.11, Labor Code.

HISTORY

1. New section filed 9-24-2013; operative 1-1-2014. Submitted to OAL as a file and print only pursuant to Government Code section 11340.9(g) (Register 2013, No. 39).