# COMAR Title 10 — Maryland Department of Health

## Subtitle 09 — Medical Care Programs

### Chapter 88 — Portable X-ray Providers

#### Regulation .07 Payment Procedures.

*COMAR 10.09.88.07*

A. General policies for payment that are applicable to all providers are set forth in COMAR 10.09.36.04.

B. The Department shall allow a single transportation payment for each trip the portable X-ray provider makes to a particular location.

C. The Department shall reimburse for covered services at the lesser of:

  (1) The provider’s customary charge unless the service is free to individuals not covered by Medicaid; or

  (2) The Department’s fee schedule.

D. The Department’s fee-schedule is contained in COMAR 10.09.02.07D.

E. Payments on Medicare cross-over claims are authorized if :

  (1) The provider accepts Medicare assignment;

  (2) Medicare makes direct payment to the provider;

  (3) Medicare has determined that the services are medically necessary;

  (4) The services are covered by the program; and

  (5) The initial billing is made directly to Medicare according to Medicare guidelines.

F. The Department shall make supplemental payment on Medicare claims subject to the following provisions:

  (1) Coinsurance shall be paid at the lesser of:

    (a) 100 percent of the coinsurance amount; or

    (b) The balance remaining after the Medicare payment is subtracted from the Medicaid rate.

G. The Program may not make a direct payment to a recipient.

H. Billing time limitations are those set forth in COMAR 10.09.36.06.

I. The provider may not bill the Program or recipient for:

  (1) Completion of forms and reports;

  (2) Broken or missed appointments;

  (3) Services rendered by mail or telephone; and

  (4) Providing a copy of a recipient’s medical record when requested by another licensed provider on behalf of the recipient.

J. The portable X-ray provider shall identify the individual who ordered the portable X-ray services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim.