On September 30, 2019, CMS published a final rule aimed at reducing Medicare regulations which may be burdensome on healthcare providers. These regulations become effective on November 29, 2019. This article only discusses the changes to portable x-ray services as found in the law.

The following summary is from the rule:

PERSONNEL REQUIREMENTS FOR PORTABLE X-RAY TECHNOLOGISTS
We are revising § 486.104(a), “Condition for coverage: Qualifications, orientation and health of technical personnel”, to focus on the qualifications of the individual performing services.

PORTABLE X-RAY REQUIREMENTS FOR ORDERS
We are revising the requirements for portable x-ray orders at § 486.106(a)(2) by removing the requirement that physician or non-physician practitioner's orders for portable x-ray services must be written and signed and replacing the specific requirements related to the content of each portable x-ray order with a cross-reference to the requirements at 42 CFR 410.32, which also apply to portable x-ray services.

Technologist Qualifications

It is no longer necessary for an operator of portable x-ray equipment to be certified through an accredited school. Instead, they must meet one of the following:

1. Successful completion of a program of formal training in X-ray technology at which the operator received appropriate training and demonstrated competence in the use of equipment and administration of portable x-ray procedures; or
2. Successful completion of 24 full months of training and experience under the direct supervision of a physician who is certified in radiology or who possesses qualifications which are equivalent to those required for such certification.

It should be noted that some Medicare payment policies and manuals discuss portable x-ray services. This ruling does not address those documents.

Chiropractic Assistant

These changes in regulations mean that a chiropractic assistant could technically operate a portable x-ray as long as they meet the requirements above. However, Medicare does not cover imaging services performed in a chiropractic office setting so unless the patient has secondary insurance that does, it won't make much of a difference for Medicare claims.

Another factor to consider is your state scope of practice laws as there may be provisions there to consider. Also be aware of individual payer requirements about who may operate x-ray machines.

X-Ray Order Requirements

A requirement was removed from the Medicare Supplemental Medical Insurance Benefits law (42 CFR 410.32) which stated that physician or nonphysician practitioner's orders for portable x-ray services must be written and signed. This should allow for more efficient ordering methods such as electronic orders.

It should be noted that this change does not remove Medicare's current requirement that a portable x-ray order must include a statement on why it is medically necessary to use a portable x-ray service instead of performing the imaging in an office or facility.

Note: See "X-Ray Reports" on page 202 of the 2020 ChiroCode DeskBook for more about what needs to be included in an imaging report.