A330

PDF page 320 / A192

Consultation
       A diagnostic radiology consultation is the service rendered when:
      a. radiographs or ultrasounds made at one institution or facility are referred to a radiologist at a
          different institution or facility for his/her written opinion. In this case, the specific elements are
          as for diagnostic radiology professional component (see page D1);
      b. a radiologist is required to make a special visit at evening or night (17:00h to 07:00h) or on a
         Saturday, Sunday or holiday to consult on the advisability of performing a diagnostic
         radiological procedure which eventually is not done. In this case, the specific elements are
         the same as for consultations; or
      c. when a radiologist is required to render an opinion prior to an interventional procedure and
         all of the following requirements are met. In this case, the specific elements are the same as
         for consultations:
           i.   the consultation is performed in an area remote from the radiologist’s normal procedural
                suite;
           ii. the requirements for a consultation are met;
           iii. the consultation is not solely for the purpose of clarifying or obtaining consent; and
           iv. the associated procedure is one of the following: J021, J025, J040, J041, J046, J048,
               J049, J050, J055, J056, J057, J058, J059, J063, J065, J066, N107, N118, N122, N125,
               S233, Z446, Z456, Z562, Z594.
 A335 Consultation............................................................................                 57.90
       Payment rules:
       1.A diagnostic radiology consultation is not eligible for payment when radiographs made in a
         different institution or facility are used for comparison purposes with radiographs or
         ultrasounds made in the consultant’s institution or facility.
       2.A335 is not eligible for payment for CT and MRI services.
       [Commentary:
       For a second opinion by a radiologist of CT and MRI studies, see A330 and A332 respectively.]

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CONSULTATIONS AND VISITS
 DIAGNOSTIC RADIOLOGY (33)
  A881 Dosimetry planning for transarterial radioembolization, per
         course of treatment ............................................................    200.00
     Radiology second opinion of CT or MRI Study
       A radiology second opinion of CT or MRI study is the service rendered when CT or MRI images
       made and interpreted by a radiologist at one institution or facility are referred to a radiologist
       (“consultant radiologist”) at a different institution or facility for his/her written interpretation. For
       the purposes of these services, “study” means all images related to one anatomical region, as
       these regions are listed in the payment rules below.
   A330 Radiology second opinion of CT study, per study...................                     103.60
   A332 Radiology second opinion of MRI study, per study.................                      231.15

PDF page 321 / A193

Payment rules:
          1.A330 and A332 are not eligible for payment when CT or MRI images made in a different
            institution or facility are used for comparison purposes with CT or MRI images made in the
            consultant radiologist’s institution or facility.
          2.A330 and A332 are limited to a maximum of one each per study per patient per 30 day
            period.
          3.For CT studies, the anatomical regions are head, neck, thorax, abdomen, pelvis, extremities
            (one or more) and spine (one or more segments).
          4.For MRI studies, the anatomical regions are head, neck, thorax, abdomen, breast(s), pelvis,
            extremities (one or more) and spine (one or more segments).
          5.E406, E407 or E408 after hours premiums for diagnostic CT/MRI services are not eligible for
            payment with A330 or A332.
          Medical record requirements:
          A330 and A332 are only eligible for payment if both the written request from the referring
          physician and the consultant radiologist’s second opinion report are included in the patient’s
          permanent medical record.

Master, record 167. Record Layout PDF, page 1.

A33020260401999999990000000000000000000000000010360000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.