Medicaid Benefits: Laboratory and X-Ray Services, outside Hospital or Clinic
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2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 51 | 2018 data limited to CN | Yes - 11 | Yes - 17 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | Yes - Mandatory | CN | No | No | - | - |
| Alaska | Yes - Mandatory | CN | $3 | No | - | - |
| Arizona | Yes - Mandatory | CN | No | No | - | - |
| Arkansas | Yes - Mandatory | CN | NR | NR | - | - |
| California | Yes - Mandatory | CN | No | Limits on individual billings for paneled lab tests, lab services for renal dialysis and hemodialysis centers not billable by labs. | - | - |
| Colorado | Yes - Mandatory | CN | $1 per visit | BRCA tests are prior authorized for all and only available for men with a personal history of breast cancer. | - | - |
| Connecticut | Yes - Mandatory | CN | No | One radiation treatment per day; three-month frequency limit on brainstem evoked response recording and CAT scan with myelography | - | - |
| Delaware | Yes - Mandatory | CN | No | Medically necessary | - | - |
| District of Columbia | Yes - Mandatory | CN | No | Some services require an UR review | - | - |
| Florida | Yes - Mandatory | CN | $1 for lab/$1 for portable x-ray services/per provider/per day | No | - | - |
| Georgia | Yes - Mandatory | CN | Yes - Not Specified | Medically necessary | - | - |
| Hawaii | Yes - Mandatory | CN | No | No | - | - |
| Idaho | Yes - Mandatory | CN | No | No | - | - |
| Illinois | Yes - Mandatory | CN | NR | NR | - | - |
| Indiana | Yes - Mandatory | CN | No | Limitations vary by specific test. | - | - |
| Iowa | Yes - Mandatory | CN | NR | NR | - | - |
| Kansas | Yes - Mandatory | CN | No | No | - | - |
| Kentucky | Yes - Mandatory | CN | $3 | No | - | - |
| Louisiana | Yes - Mandatory | CN | No | NR | - | - |
| Maine | Yes - Mandatory | CN | $.50 to $1/day depending on payment amount, up to $10/month | No | - | - |
| Maryland | Yes - Mandatory | CN | No | No | - | - |
| Massachusetts | Yes - Mandatory | CN | No | No | - | - |
| Michigan | Yes - Mandatory | CN | No | No | - | - |
| Minnesota | Yes - Mandatory | CN | $3 copay for non-preventive office visits | No | - | - |
| Mississippi | Yes - Mandatory | CN | No | NR | - | - |
| Missouri | Yes - Mandatory | CN | $1 | Certain high-tech and cardiac imaging procedure codes require precertification for services delivered in the outpatient setting. These services are exempt from the precertification requirement when performed in emergency situations or while the participant is in outpatient observation. Medicare covered services provided on participants with active Medicare Part B are also exempt from the precertification requirement. Participants with Medicare Part C coverage and do not have QMB benefits are required to obtain a precertification. | - | - |
| Montana | Yes - Mandatory | CN | Income at or below 100% FPL - $4 per visit; above FPL - 10% of payment amount | PA required for selected MRI and CT procedures for head/brain | - | - |
| Nebraska | Yes - Mandatory | CN | No | No | - | - |
| Nevada | Yes - Mandatory | CN | NR | NR | - | - |
| New Hampshire | Yes - Mandatory | CN | No | NR | - | - |
| New Jersey | Yes - Mandatory | CN | No | No | - | - |
| New Mexico | Yes - Mandatory | CN | No | No | - | - |
| New York | Yes - Mandatory | CN | NR | NR | - | - |
| North Carolina | Yes - Mandatory | CN | No | DOS is day test collected. Labs must have CLIA. Outpatient lab not counted toward visit limit.Ordered by Licensed provider | - | - |
| North Dakota | Yes - Mandatory | CN | No | No | - | - |
| Ohio | Yes - Mandatory | CN | No | No | - | - |
| Oklahoma | Yes - Mandatory | CN | $4 per visit | Limitations vary by service | - | - |
| Oregon | Yes - Mandatory | CN | No | No | - | - |
| Pennsylvania | Yes - Mandatory | CN | No | $1.00 copayment for technical component of diagnostic radiology, nuclear medicine, medical diagnostic test, and radiation therapy. | - | - |
| Rhode Island | Yes - Mandatory | CN | No | Payment review/denial if duplicate services same date. | - | - |
| South Carolina | Yes - Mandatory | CN | NR | NR | - | - |
| South Dakota | Yes - Mandatory | CN | No | NR | - | - |
| Tennessee | Yes - Mandatory | CN | No | No | - | - |
| Texas | Yes - Mandatory | CN | No | No | - | - |
| Utah | Yes - Mandatory | CN | No | No | - | - |
| Vermont | Yes - Mandatory | CN | No | Certain high-tech imaging services require prior authorization; 8 lab tests for urine drug testing per month | - | - |
| Virginia | Yes - Mandatory | CN | No | NR | - | - |
| Washington | Yes - Mandatory | CN | No | Some labs and advanced imaging require PA | - | - |
| West Virginia | Yes - Mandatory | CN | No | Advanced imaging such as MRI's and CT's require prior authorization from our Utilization Management Contractor (UMC). The bone density test is limited to one every two years. More frequent requests will require prior authorization with documentation of the medical necessity. Transportation of portable x-ray equipment is reimbursable only when the equipment used is transported to the location where the x-ray services are provided. West Virginia Medicaid will not reimburse for transportation of portable x-ray equipment when the x-ray equipment is stored at the facility for use as needed. Also, specific genetic tests require prior authorization, along with service limits on drug screening/testing. | - | - |
| Wisconsin | Yes - Mandatory | CN | $1.00 copayment per lab test in a physician office; no copayment for lab test performed by an independent lab; Copay for radiology is $3.00 per procedure. No copay for radiation oncology services and on some lab tests. Copayment capped (along with other physician services) at $30 per provider, per calendar year. | Centralized prior approval, through a radiology benefits manager, for most advanced imaging services; a small number of lab testing requires prior approval | - | - |
| Wyoming | Yes - Mandatory | CN | No | No | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 12 No - 44 | ||||
| Alabama | Yes | CN | Fee for service | |||
| Alaska | Yes | CN | Fee for service, and using Medicare payment ceilings for lab services | |||
| American Samoa | Yes | See territory-specific FN | Most on-island services provided by LBJ Tropical Medical Center | |||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | $500/year limit on all lab and most x-ray services | Fee for service, and using Medicare payment ceilings for lab services | ||
| California | Yes | CN & MN | Limits on individual billings for paneled lab tests, lab services for renal dialysis and hemodialysis centers not billable by labs | Portable x-ray services other than in nursing facilities | Fee for service, portable x-ray services paid reasonable charge | |
| Colorado | Yes | CN | $1/date of service | Non-emergency CT and MRI scans performed in specified settings and all PET scans | Fee for service | |
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | Yes | CN & MN | Fee for service | |||
| Florida | Yes | CN & MN | $1/day, including portable x-ray services | In-home portable x-ray services must be medically justified | Fee for service | |
| Georgia | Yes | CN & MN | Portable x-ray services not covered | Specified high cost tests and services | Fee for service, based on CMS rates | |
| Guam | Yes | CN | Fee for service using Medicare fee schedule | |||
| Hawaii | Yes | CN & MN | Specified procedures | Fee for service | ||
| Idaho | Yes | CN | Fee for service, and using Medicare payment ceilings for lab services | |||
| Illinois | Yes | CN & MN | Fee for service using Medicare payment ceilings | |||
| Indiana | Yes | CN | Fee for service | |||
| Iowa | Yes | CN & MN | High tech radiology/imaging procedures | Fee for service | ||
| Kansas | Yes | CN & MN | Specified lab and x-ray procedures only | Fee for service | ||
| Kentucky | Yes | A, B & C - See state-specific FN | A - $3/service | Fee for service using Medicare payment ceilings | ||
| Louisiana | Yes | CN & MN | Specified high-tech imaging studies | Fee for service | ||
| Maine | Yes | CN & MN | $.50-$1/day, depending on payment up to $10/month for each service type | Specified procedures | Fee for service | |
| Maryland | Yes | CN & MN | Fee for service | |||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | Selected services | Fee for service | ||
| Minnesota | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Mississippi | Yes | CN | Fee for service using a percentage of Medicare allowable payment as ceiling | |||
| Missouri | Yes | CN | $1/day | Specified services | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | Fee for service | |||
| Nebraska | Yes | CN & MN | Fee for service, and using Medicare payment ceilings for lab services | |||
| Nevada | Yes | CN | Specified services | Fee for service | ||
| New Hampshire | Yes | CN & MN | 15 diagnostic x-ray services/year; radiation therapy does not count against limit | Specified x-ray services | Fee for service | |
| New Jersey | Yes | CN & MN | Portable x-ray services only in nursing facilities or as emergency | Fee for service | ||
| New Mexico | Yes | CN | Specified services | Fee for service using Medicare payment ceilings | ||
| New York | Yes | CN & MN | $.50/lab test, $1/x-ray | Beneficiary Specific Utilization Thresholds apply - see state-specific FN | Fee for service, and using Medicare payment ceilings for lab services | |
| North Carolina | Yes | CN & MN | Specified high-tech imaging services and ultrasounds | Fee for service | ||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | Fee for service | |||
| Oklahoma | Yes | CN | $3/visit | Fee for service | ||
| Oregon | Yes | A & B - See state-specific FN | Services limited to funded conditions on the priority list | Specified services | Fee for service, using Medicare Relative Value Units and a state conversion factor | |
| Pennsylvania | Yes | CN & MN | $1/x-ray | Fee for service | ||
| Puerto Rico | Yes | CN & MN | $.50-$1/test | Primary care physician referral required | Service is included in the capitated rate paid to managed care plans | |
| Rhode Island | Yes | See state-specific FN | Specified services | Fee for service | ||
| South Carolina | Yes | CN | Fee for service | |||
| South Dakota | Yes | CN | Fee for service for high volume procedures, percentage of charge for low volume procedures | |||
| Tennessee | Yes | A, B & C - See state-specific FN | See state-specific FN | |||
| Texas | Yes | CN & MN | Specified services | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | C - 5% of lab payment over $50 or x-ray payment over $100 | C - limited to services related to primary care | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | Urine drug testing limited to 8/month | High-tech imaging services | Fee for service | |
| U.S. Virgin Islands | Yes | CN | Services in public health facilities only | Fee for service | ||
| Virginia | Yes | CN & MN | $1/visit if the only service provided that day | Limits vary by service | Non-emergent outpatient diagnostic scans | Fee for service |
| Washington | Yes | CN & MN | Specified services | Fee for service | ||
| West Virginia | Yes | A, B & C | Fee for service, and using a percentage of Medicare payment ceilings for lab services | |||
| Wisconsin | Yes | CN & MN | $1/day for lab test, $2/day for diagnostic lab test or x-ray, $3/day for other radiology service | Portable x-ray services only in nursing facilities | Fee for service | |
| Wyoming | Yes | CN | Fee for service |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 12 No - 44 | ||||
| Alabama | Yes | CN | Reasonable charge | |||
| Alaska | Yes | CN | Fee for service, and using Medicare payment ceilings for lab services | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | $500/year limit on all lab and most x-ray services | Fee for service, and using Medicare payment ceilings for lab services | ||
| California | Yes | CN & MN | Limits on individual billings for paneled lab tests, lab services for renal dialysis and hemodialysis centers not billable by labs | Portable x-ray services other than in nursing facilities | Fee for service, portable x-ray services paid reasonable charge | |
| Colorado | Yes | CN | $1/date of service | Non-emergency CT and MRI scans performed in specified settings and all PET scans | Fee for service | |
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | Yes | CN & MN | Fee for service | |||
| Florida | Yes | CN & MN | $1/day, including portable x-ray services | In-home portable x-ray services must be medically justified | Fee for service | |
| Georgia | Yes | CN & MN | Portable x-ray services not covered | Specified high cost tests and services | Fee for service, based on CMS rates | |
| Guam | Yes | CN | Fee for service | |||
| Hawaii | Yes | CN & MN | Specified procedures | Fee for service | ||
| Idaho | Yes | CN | Fee for service, and using Medicare payment ceilings for lab services | |||
| Illinois | Yes | CN & MN | Total body scans limited to inpatient hospital setting | Fee for service using Medicare payment ceilings | ||
| Indiana | Yes | CN | Fee for service | |||
| Iowa | Yes | CN & MN | High tech radiology/imaging procedures | Fee for service | ||
| Kansas | Yes | CN & MN | Specified lab and x-ray procedures only | Fee for service | ||
| Kentucky | Yes | A, B & C - See state-specific FN | A - $3/service | Fee for service using Medicare payment ceilings | ||
| Louisiana | Yes | CN & MN | Specified high-tech imaging studies | Fee for service | ||
| Maine | Yes | CN & MN | $.50-$1/day, depending on payment up to $10/month for each service type | Specified procedures | Fee for service | |
| Maryland | Yes | CN & MN | Fee for service | |||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | Selected services | Fee for service | ||
| Minnesota | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Mississippi | Yes | CN | Fee for service using a percentage of Medicare allowable payment as ceiling | |||
| Missouri | Yes | CN | $1/day | Specified services | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | Fee for service | |||
| Nebraska | Yes | CN & MN | Fee for service, and using Medicare payment ceilings for lab services | |||
| Nevada | Yes | CN | Specified services | Fee for service | ||
| New Hampshire | Yes | CN & MN | 15 diagnostic x-ray services/year | Specified x-ray services | Fee for service | |
| New Jersey | Yes | CN & MN | Portable x-ray services only in nursing facilities or as emergency | Fee for service | ||
| New Mexico | Yes | CN | Specified services | Fee for service using Medicare payment ceilings | ||
| New York | Yes | CN & MN | $.50/lab test, $1/x-ray | Beneficiary Specific Utilization Thresholds apply - see state-specific FN | Fee for service, and using Medicare payment ceilings for lab services | |
| North Carolina | Yes | CN & MN | Specified high-tech imaging services and ultrasounds | Fee for service using Medicare payment ceilings | ||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | Fee for service | |||
| Oklahoma | Yes | CN | $3/visit | Fee for service | ||
| Oregon | Yes | A & B - See state-specific FN | Services limited to funded conditions on the priority list | Specified services | Fee for service, using Medicare Relative Value Units and a state conversion factor | |
| Pennsylvania | Yes | CN & MN | $1/x-ray | Fee for service | ||
| Puerto Rico | Yes | CN & MN | $.50-$1/test | Primary care physician referral required | Service is included in the capitated rate paid to managed care plans | |
| Rhode Island | Yes | See state-specific FN | Specified services | Fee for service | ||
| South Carolina | Yes | CN | Fee for service | |||
| South Dakota | Yes | CN | Fee for service for high volume procedures, percentage of charge for low volume procedures | |||
| Tennessee | Yes | A & B - See state-specific FN | See state-specific FN | |||
| Texas | Yes | CN & MN | Specified services | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | C - 5% of lab payment over $50 or x-ray payment over $100 | C - limited to services related to primary care | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | Urine drug testing limited to 8/month | High-tech imaging services | Fee for service | |
| U.S. Virgin Islands | Yes | CN | Services in public health facilities only | Fee for service | ||
| Virginia | Yes | CN & MN | $1/visit | Limits vary by service | Non-emergent outpatient diagnostic scans | Fee for service |
| Washington | Yes | CN & MN | Specified services | Fee for service | ||
| West Virginia | Yes | A, B & C | Fee for service, and using a percentage of Medicare payment ceilings for lab services | |||
| Wisconsin | Yes | CN & MN | $1/day for lab test, $2/day for diagnostic lab test or x-ray, $3/day for other radiology service | Portable x-ray services only in nursing facilities | Fee for service | |
| Wyoming | Yes | CN | Fee for service |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 10 No - 46 | ||||
| Alabama | Yes | CN | Reasonable charge | |||
| Alaska | Yes | CN | Fee for service, and using Medicare payment ceilings for lab services | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | $500/year limit on all lab and most x-ray services | Fee for service, and using Medicare payment ceilings for lab services | ||
| California | Yes | CN & MN | Limits on individual billings for paneled lab tests, lab services for renal dialysis and hemodialysis centers not billable by labs | Portable x-ray services other than in nursing facilities | Fee for service, portable x-ray services paid reasonable charge | |
| Colorado | Yes | CN | $1/date of service | Fee for service | ||
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | Yes | CN & MN | Fee for service | |||
| Florida | Yes | CN & MN | $1/day, including portable x-ray services | In-home portable x-ray services must be medically justified | Fee for service | |
| Georgia | Yes | CN & MN | Portable x-ray services not covered | Specified high cost tests and services | Fee for service, based on CMS rates | |
| Guam | Yes | CN | Fee for service | |||
| Hawaii | Yes | CN & MN | Specified procedures | Fee for service | ||
| Idaho | Yes | CN | Fee for service, and using Medicare payment ceilings for lab services | |||
| Illinois | Yes | CN & MN | Total body scans limited to inpatient hospital setting | Fee for service using Medicare payment ceilings | ||
| Indiana | Yes | CN | Fee for service | |||
| Iowa | Yes | CN & MN | Fee for service | |||
| Kansas | Yes | CN & MN | Specified lab and x-ray procedures only | Fee for service | ||
| Kentucky | Yes | A, B & C - See state-specific FN | A - $3/service | Fee for service using Medicare payment ceilings | ||
| Louisiana | Yes | CN & MN | Fee for service | |||
| Maine | Yes | CN & MN | $.50-$1/day, depending on payment up to $10/month for each service type | Specified procedures | Fee for service | |
| Maryland | Yes | CN & MN | Fee for service | |||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | Selected services | Fee for service | ||
| Minnesota | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Mississippi | Yes | CN | Fee for service using a percentage of Medicare allowable payment as ceiling | |||
| Missouri | Yes | CN | $1/day | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | Fee for service | |||
| Nebraska | Yes | CN & MN | Fee for service, and using Medicare payment ceilings for lab services | |||
| Nevada | Yes | CN | Specified services | Fee for service | ||
| New Hampshire | Yes | CN & MN | 15 diagnostic x-ray services/year | Specified x-ray services | Fee for service | |
| New Jersey | Yes | CN & MN | Portable x-ray services only in nursing facilities or as emergency | Fee for service | ||
| New Mexico | Yes | CN | Specified services | Fee for service using Medicare payment ceilings | ||
| New York | Yes | CN & MN | $.50/lab test, $1/x-ray | 18 lab tests/year | Fee for service, and using Medicare payment ceilings for lab services | |
| North Carolina | Yes | CN & MN | Fee for service using Medicare payment ceilings | |||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | Fee for service | |||
| Oklahoma | Yes | CN | $1-$3/service depending on payment | Fee for service | ||
| Oregon | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Pennsylvania | Yes | CN & MN | $1/x-ray | Fee for service | ||
| Puerto Rico | Yes | CN & MN | Primary care physician referral required | Fee for service | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | Specified services | Fee for service | ||
| South Carolina | Yes | CN | Fee for service | |||
| South Dakota | Yes | CN | Fee for service for high volume procedures, percentage of charge for low volume procedures | |||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | Yes | CN & MN | Specified services | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | C - 5% of lab payment over $50 or x-ray payment over $100 | C - limited to services related to primary care | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | Yes | CN | Services in public health facilities only | Fee for service | ||
| Virginia | Yes | CN & MN | Limits vary by service | Non-emergent outpatient diagnostic scans | Fee for service | |
| Washington | Yes | CN & MN | Specified services | Fee for service | ||
| West Virginia | Yes | A, B & C | Fee for service, and using a percentage of Medicare payment ceilings for lab services | |||
| Wisconsin | Yes | CN & MN | $1/day for lab test, $2/day for diagnostic lab test or x-ray, $3/day for other radiology service | Portable x-ray services only in nursing facilities | Fee for service | |
| Wyoming | Yes | CN | Fee for service |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 11 No - 45 | ||||
| Alabama | Yes | CN | 20 lab services/year, 4 radiology services/year but limit doesn't apply to radiation oncology and therapeutic radiology | Reasonable charge | ||
| Alaska | Yes | CN | Fee for service, and using Medicare payment ceilings for lab services | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | $500/year limit on all lab and most x-ray services | Fee for service, and using Medicare payment ceilings for lab services | ||
| California | Yes | CN & MN | Limits on individual billings for paneled lab tests, lab services for renal dialysis and hemodialysis centers not billable by labs | Portable x-ray services other than in nursing facilities | Fee for service, portable x-ray services paid reasonable charge | |
| Colorado | Yes | CN | $1/date of service | Fee for service | ||
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | Yes | CN & MN | Fee for service | |||
| Florida | Yes | CN & MN | $1/day, including portable x-ray services | In-home portable x-ray services must be medically justified | Fee for service | |
| Georgia | Yes | CN & MN | Portable x-ray services not covered | Specified high cost tests and services | Fee for service | |
| Guam | Yes | CN | Fee for service | |||
| Hawaii | Yes | CN & MN | Fee for service | |||
| Idaho | Yes | CN | Fee for service, and using Medicare payment ceilings for lab services | |||
| Illinois | Yes | CN & MN | Total body scans limited to inpatient hospital setting | Fee for service using Medicare payment ceilings | ||
| Indiana | Yes | CN | Fee for service | |||
| Iowa | Yes | CN & MN | Fee for service | |||
| Kansas | Yes | CN & MN | CT scans for diagnosis only | Fee for service | ||
| Kentucky | Yes | A, B & C - See state-specific FN | A - $3/service | Fee for service using Medicare payment ceilings | ||
| Louisiana | Yes | CN & MN | Fee for service | |||
| Maine | Yes | CN & MN | $.50-$1/day, depending on payment up to $10/month for each service type | Fee for service | ||
| Maryland | Yes | CN & MN | Fee for service | |||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | Fee for service | |||
| Minnesota | Yes | A & B - See state-specific FN | B - $3/diagnostic test - See state-specific FN | Specified services | Fee for service | |
| Mississippi | Yes | CN | Fee for service using a percentage of Medicare allowable payment as ceiling | |||
| Missouri | Yes | CN | $1/day | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | Fee for service | |||
| Nebraska | Yes | CN & MN | Fee for service, and using Medicare payment ceilings for lab services | |||
| Nevada | Yes | CN | Fee for service | |||
| New Hampshire | Yes | CN & MN | 15 diagnostic x-ray services/year | Specified services | Fee for service | |
| New Jersey | Yes | CN & MN | Portable x-ray services only in nursing facilities or as emergency | Fee for service | ||
| New Mexico | Yes | CN | Specified services | Fee for service using Medicare payment ceilings | ||
| New York | Yes | CN & MN | $.50/lab test, $1/x-ray | 18 lab tests/year | Fee for service, and using Medicare payment ceilings for lab services | |
| North Carolina | Yes | CN & MN | Fee for service using Medicare payment ceilings | |||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | Fee for service | |||
| Oklahoma | Yes | CN | $1-$3/service depending on payment | Fee for service | ||
| Oregon | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Pennsylvania | Yes | CN & MN | $1/x-ray or diagnostic test | Fee for service | ||
| Puerto Rico | Yes | CN & MN | Primary care physician referral required | Fee for service | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | Specified services | Fee for service | ||
| South Carolina | Yes | CN | Fee for service | |||
| South Dakota | Yes | CN | Fee for service for high volume procedures, percentage of charge for low volume procedures | |||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | Yes | CN & MN | Specified services | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | C - 5% of lab payment over $50 or x-ray payment over $100 | C - limited to services related to primary care | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | Yes | CN | Services in public health facilities only | Fee for service | ||
| Virginia | Yes | CN & MN | Specified services | Non-emergent outpatient diagnostic scans | Fee for service | |
| Washington | Yes | CN & MN | Specified services | Fee for service | ||
| West Virginia | Yes | CN & MN | Fee for service, and using a percentage of Medicare payment ceilings for lab services | |||
| Wisconsin | Yes | CN & MN | $1/day for lab test, $2/day for diagnostic lab test or x-ray, $3/day for other radiology service | Portable x-ray services only in nursing facilities | Fee for service | |
| Wyoming | Yes | CN | Fee for service |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 9 No - 47 | ||||
| Alabama | Yes | CN | Reasonable charge | |||
| Alaska | Yes | CN | Fee for service, and using Medicare payment ceilings for lab services | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | $500/year limit on all lab and most x-ray services | Fee for service, and using Medicare payment ceilings for lab services | ||
| California | Yes | CN & MN | Limits on individual billings for paneled lab tests, lab services for renal dialysis and hemodialysis centers not billable by labs | Portable x-ray services other than in nursing facilities | Fee for service, portable x-ray services paid reasonable charge | |
| Colorado | Yes | CN | $1/date of service | Fee for service | ||
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | Yes | CN & MN | Fee for service | |||
| Florida | Yes | CN & MN | $1/day, including portable x-ray services | Portable x-ray services must be medically justified | Fee for service | |
| Georgia | Yes | CN & MN | Portable x-ray services not covered | Specified high cost tests and services | Fee for service | |
| Guam | Yes | CN | Fee for service | |||
| Hawaii | Yes | CN & MN | Fee for service | |||
| Idaho | Yes | CN | Fee for service, and using Medicare payment ceilings for lab services | |||
| Illinois | Yes | CN & MN | Total body scans limited to inpatient hospital setting | Fee for service using Medicare payment ceilings | ||
| Indiana | Yes | CN | Fee for service | |||
| Iowa | Yes | CN & MN | Fee for service | |||
| Kansas | Yes | CN & MN | CT scans for diagnosis only | Fee for service | ||
| Kentucky | Yes | CN & MN | Fee for service using Medicare payment ceilings | |||
| Louisiana | Yes | CN & MN | Fee for service | |||
| Maine | Yes | CN & MN | $.50-$1/day, depending on payment up to $10/month for each service type | Fee for service | ||
| Maryland | Yes | CN & MN | Fee for service | |||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | Fee for service | |||
| Minnesota | Yes | A & B - See state-specific FN | B - $3/diagnostic test - See state-specific FN | Specified services | Fee for service | |
| Mississippi | Yes | CN | Fee for service using a percentage of Medicare allowable payment as ceiling | |||
| Missouri | Yes | CN | Fee for service | |||
| Montana | Yes | A & B - See state-specific FN | Fee for service | |||
| Nebraska | Yes | CN & MN | Fee for service, and using Medicare payment ceilings for lab services | |||
| Nevada | Yes | CN | Fee for service | |||
| New Hampshire | Yes | CN & MN | 15 diagnostic x-ray services/year | Fee for service | ||
| New Jersey | Yes | CN & MN | Portable x-ray services only in nursing facilities or as emergency | Fee for service | ||
| New Mexico | Yes | CN | Specified services | Fee for service using Medicare payment ceilings | ||
| New York | Yes | CN & MN | $.50/lab test, $1/x-ray | 18 lab tests/year | Fee for service, and using Medicare payment ceilings for lab services | |
| North Carolina | Yes | CN & MN | Fee for service using Medicare payment ceilings | |||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | Fee for service | |||
| Oklahoma | Yes | CN | $1-$3/service depending on payment | Fee for service | ||
| Oregon | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Pennsylvania | Yes | CN & MN | $1/visit(x-ray only) | Fee for service | ||
| Puerto Rico | Yes | CN & MN | Primary care physician referral required | Fee for service | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | Specified services | Fee for service | ||
| South Carolina | Yes | CN | Fee for service | |||
| South Dakota | Yes | CN | Fee for service for high volume procedures, percentage of charge for low volume procedures | |||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | Yes | CN & MN | Specified services | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | C - 5% of lab charge over $50 or x-ray charge over $100 | C - limited to services related to primary care | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | Yes | CN | Services in public health facilities only | Fee for service | ||
| Virginia | Yes | CN & MN | Specified services | Fee for service | ||
| Washington | Yes | CN & MN | Specified services | Fee for service | ||
| West Virginia | Yes | CN & MN | Fee for service, and using a percentage of Medicare payment ceilings for lab services | |||
| Wisconsin | Yes | CN & MN | $1/day for lab test, $2/day for diagnostic lab test or x-ray | Portable x-ray services only in nursing facilities | Fee for service | |
| Wyoming | Yes | CN | Fee for service |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 7 No - 49 | ||||
| Alabama | Yes | CN | Reasonable charge | |||
| Alaska | Yes | CN | Fee for service, and using Medicare payment ceilings for lab services | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | $500/year limit on all lab and most x-ray services | Fee for service, and using Medicare payment ceilings for lab services | ||
| California | Yes | CN & MN | Limits on individual billings for paneled lab tests, lab services for renal dialysis and hemodialysis centers not billable by labs | Portable x-ray services other than in nursing facilities | Fee for service, portable x-ray services paid reasonable charge | |
| Colorado | Yes | CN | Fee for service | |||
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | Yes | CN & MN | Fee for service | |||
| Florida | Yes | CN & MN | $1/day, including portable x-ray services | Portable x-ray services must be medically justified | Fee for service | |
| Georgia | Yes | CN & MN | Portable x-ray services not covered | Specified high cost tests and services | Fee for service | |
| Guam | Yes | CN | Fee for service | |||
| Hawaii | Yes | CN & MN | Fee for service | |||
| Idaho | Yes | CN | Fee for service, and using Medicare payment ceilings for lab services | |||
| Illinois | Yes | CN & MN | Total body scans limited to inpatient hospital setting | Fee for service using Medicare payment ceilings | ||
| Indiana | Yes | CN | Fee for service | |||
| Iowa | Yes | CN & MN | Fee for service | |||
| Kansas | Yes | CN & MN | CT scans for diagnosis only | Fee for service | ||
| Kentucky | Yes | CN & MN | Fee for service using Medicare payment ceilings | |||
| Louisiana | Yes | CN & MN | Fee for service | |||
| Maine | Yes | CN & MN | $.50-$1/day, depending on payment up to $10/month for each service type | Fee for service | ||
| Maryland | Yes | CN & MN | Fee for service | |||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | Fee for service | |||
| Minnesota | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Mississippi | Yes | CN | Fee for service using a percentage of Medicare allowable payment as ceiling | |||
| Missouri | Yes | CN | Fee for service | |||
| Montana | Yes | CN & MN | Fee for service | |||
| Nebraska | Yes | CN & MN | Fee for service, and using Medicare payment ceilings for lab services | |||
| Nevada | Yes | CN | Fee for service | |||
| New Hampshire | Yes | CN & MN | 15 diagnostic x-ray services/year | Fee for service | ||
| New Jersey | Yes | CN & MN | Portable x-ray services only in nursing facilities or as emergency | Fee for service | ||
| New Mexico | Yes | CN | Specified services | Fee for service using Medicare payment ceilings | ||
| New York | Yes | CN & MN | $.50/lab test, $1/x-ray | 18 lab tests/year | Fee for service, and using Medicare payment ceilings for lab services | |
| North Carolina | Yes | CN & MN | Fee for service using Medicare payment ceilings | |||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | Fee for service | |||
| Oklahoma | Yes | CN & MN | $1-$3/service depending on payment | Fee for service | ||
| Oregon | Yes | CN & MN | Specified services | Fee for service | ||
| Pennsylvania | Yes | CN & MN | $1/visit(x-ray only) | Fee for service | ||
| Puerto Rico | Yes | CN & MN | Primary care physician referral required | Fee for service | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | Specified services | Fee for service | ||
| South Carolina | Yes | CN | Fee for service | |||
| South Dakota | Yes | CN | Fee for service for high volume procedures, percentage of charge for low volume procedures | |||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | Yes | CN & MN | Specified services | Fee for service | ||
| Utah | Yes | A, B & C - See state specific FN | C - 5% of lab charge over $50 or x-ray charge over $100 | C - limited to services related to primary care | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | Fee for service | |||
| U.S. Virgin Islands | Yes | CN | Services in public health facilities only | Fee for service | ||
| Virginia | Yes | CN & MN | Fee for service | |||
| Washington | Yes | CN & MN | Specified services | Fee for service | ||
| West Virginia | Yes | CN & MN | Fee for service, and using a percentage of Medicare payment ceilings for lab services | |||
| Wisconsin | Yes | CN & MN | $1/day for lab test, $2/day for x-ray | Portable x-ray services only in nursing facilities | Fee for service | |
| Wyoming | Yes | CN | Fee for service |