Have you ever wondered why an x-ray company located in Miami is billing for x-ray services provided to patients in Ft. Lauderdale, West Palm Beach, Lake Worth or Naples? Mostly because of CPT code Q0092.
Q0092 is defined as the “Set Up of Portable X-Ray Equipment.” Q0092 is one of the most commonly abused CPT codes; however, there are some restrictions on when CPT code Q0092 may be utilized. For example, Florida Administrative Code 64E-5.502(1)(a)8c states that “Portable or mobile equipment shall be used only for examinations where it is impractical to transfer the patient to a stationary radiographic installation.”
Thus, in order to qualify for reimbursement for CPT code Q0092, it must have been impractical, due to injuries, time constraints, or whatever reason, to move the patient to a physical location where stationary x-ray equipment is located, thereby necessitating the set up of mobile, portable x-ray equipment at the patient’s location. Something you would not expect to see very often.
The Center for Medicare & Medicaid Services instructs “suppliers of portable x-ray services to use code ‘Q0092’ when billing for set-up costs when the equipment is used in a home or nursing facility.” In addition, the actual x-ray equipment being utilized must in-fact be portable equipment, meaning it cannot be attached in any way to any building. It must specifically be set-up for mobile deployment and usage.
Pinnacle Business Solutions, a Medicare Intermediary, instructs that “Medicare will pay for the set-up of each radiological procedure (other than retakes of the same procedure) during both single and multiple patient trips. Use code Q0092 to bill for the set-up component of radiological services. Diagnostic x-rays furnished by a portable x-ray supplier are covered under Part B when furnished in a place of residence used as the patient’s home.” In addition, Pinnacle business Solutions advises that Q0092 should also be divided among the number of patients which are receiving x-rays at the same location. Thus, if 15 patients received radiological services from the portable x-ray unit in one day at the same location, the set-up costs billed under Q0092 should be apportioned equally among those 15 people.
Lately, we have seen many instances of x-ray diagnostic businesses traveling outside of their facilities to provide mobile x-rays services directly at the patient’s therapy center or chiropractor’s office and then submit a bill to the insurer requesting reimbursement for CPT code Q0092.
However, upon further investigation, it is discovered that the diagnostic equipment was actually stationary and not mobile at all or the diagnostic equipment was already located at the treating facility. In some cases, the patient traveled to another clinic to have the diagnostic services performed. Thus, although Q0092 may be frequently billed, in many instances, there may not be a reasonable basis for the charge.
Further, Q0092 is commonly abused as there is no simple way for an insurer to determine whether or not it was impractical to transfer that patient to a stationary x-ray machine, and moreover, even if there was, the determination could be subjective to a certain degree. However, there are certainly some important patterns regarding the use of this CPT code that you can keep an eye on. For example, in some cases, the principal place of business for the diagnostic facility is not in the same county where the x-ray’s services are provided. In other cases, the diagnostic center’s documents may omit a prescription for the specific diagnostic testing provided.
Whatever the case may be, with the consistently increasing popularity of mobile x-rays, MRI, and other mobile diagnostic services, we are sure to see a rise in the amount of bills seeking reimbursement for CPT code Q0092 in the future. Get ahead of this trend. Contact The Goldstein Law Group to discuss the many characteristics and patterns of billing under this code.
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