| Is the Benefit Covered? |
Copayment Requirement |
Prior Approval Requirement |
Coverage Limitations |
Reimbursement Methodology |
Populations Covered |
|
|
Alabama
|
|
Yes
|
|
|
|
Reasonable charge
|
CN
|
|
Alaska
|
|
Yes
|
|
|
|
Fee for service, and using Medicare payment ceilings for lab services
|
CN
|
|
Arizona
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Arkansas
|
|
Yes
|
|
|
$500/year limit on all lab and most x-ray services
|
Fee for service, and using Medicare payment ceilings for lab services
|
CN & MN
|
|
California
|
|
Yes
|
|
Portable x-ray services other than in nursing facilities
|
Limits on individual billings for paneled lab tests, lab services for renal dialysis and hemodialysis centers not billable by labs
|
Fee for service, portable x-ray services paid reasonable charge
|
CN & MN
|
|
Colorado
|
|
Yes
|
$1/date of service
|
|
|
Fee for service
|
CN
|
|
Connecticut
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Delaware
|
|
Yes
|
|
|
|
Fee for service
|
CN
|
|
District of Columbia
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Florida
|
|
Yes
|
$1/day, including portable x-ray services
|
|
In-home portable x-ray services must be medically justified
|
Fee for service
|
CN & MN
|
|
Georgia
|
|
Yes
|
|
Specified high cost tests and services
|
Portable x-ray services not covered
|
Fee for service, based on CMS rates
|
CN & MN
|
|
Hawaii
|
|
Yes
|
|
Specified procedures
|
|
Fee for service
|
CN & MN
|
|
Idaho
|
|
Yes
|
|
|
|
Fee for service, and using Medicare payment ceilings for lab services
|
CN
|
|
Illinois
|
|
Yes
|
|
|
Total body scans limited to inpatient hospital setting
|
Fee for service using Medicare payment ceilings
|
CN & MN
|
|
Indiana
|
|
Yes
|
|
|
|
Fee for service
|
CN
|
|
Iowa
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Kansas
|
|
Yes
|
|
|
Specified lab and x-ray procedures only
|
Fee for service
|
CN & MN
|
|
Kentucky
|
|
Yes
|
A - $3/service
|
|
|
Fee for service using Medicare payment ceilings
|
A, B, C & D - See state-specific FN
|
|
Louisiana
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Maine
|
|
Yes
|
$.50-$1/day, depending on payment up to $10/month for each service type
|
Specified procedures
|
|
Fee for service
|
CN & MN
|
|
Maryland
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Massachusetts
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Michigan
|
|
Yes
|
|
Selected services
|
|
Fee for service
|
CN & MN
|
|
Minnesota
|
|
Yes
|
B - $3/diagnostic test - See state-specific FN
|
Specified services
|
|
Fee for service
|
A & B - See state-specific FN
|
|
Mississippi
|
|
Yes
|
|
|
|
Fee for service using a percentage of Medicare allowable payment as ceiling
|
CN
|
|
Missouri
|
|
Yes
|
$1/day
|
|
|
Fee for service
|
CN & MN
|
|
Montana
|
|
Yes
|
$4/service
|
|
|
Fee for service
|
A & B - See state-specific FN
|
|
Nebraska
|
|
Yes
|
|
|
|
Fee for service, and using Medicare payment ceilings for lab services
|
CN & MN
|
|
Nevada
|
|
Yes
|
|
Specified services
|
|
Fee for service
|
CN
|
|
New Hampshire
|
|
Yes
|
|
Specified x-ray services
|
15 diagnostic x-ray services/year
|
Fee for service
|
CN & MN
|
|
New Jersey
|
|
Yes
|
|
|
Portable x-ray services only in nursing facilities or as emergency
|
Fee for service
|
CN & MN
|
|
New Mexico
|
|
Yes
|
|
Specified services
|
|
Fee for service using Medicare payment ceilings
|
CN
|
|
New York
|
|
Yes
|
$.50/lab test, $1/x-ray
|
|
18 lab tests/year
|
Fee for service, and using Medicare payment ceilings for lab services
|
CN & MN
|
|
North Carolina
|
|
Yes
|
|
|
|
Fee for service using Medicare payment ceilings
|
CN & MN
|
|
North Dakota
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Ohio
|
|
Yes
|
|
|
|
Fee for service
|
CN
|
|
Oklahoma
|
|
Yes
|
$1-$3/service depending on payment
|
|
|
Fee for service
|
CN
|
|
Oregon
|
|
Yes
|
|
Specified services
|
|
Fee for service
|
A & B - See state-specific FN
|
|
Pennsylvania
|
|
Yes
|
$1/x-ray
|
|
|
Fee for service
|
CN & MN
|
|
Rhode Island
|
|
Yes
|
|
Specified services
|
|
Fee for service
|
CN & MN - see state-specific FN
|
|
South Carolina
|
|
Yes
|
|
|
|
Fee for service
|
CN
|
|
South Dakota
|
|
Yes
|
|
|
|
Fee for service for high volume procedures, percentage of charge for low volume procedures
|
CN
|
|
Tennessee
|
|
Yes
|
|
|
|
|
A & B - See state-specific FN
|
|
Texas
|
|
Yes
|
|
Specified services
|
|
Fee for service
|
CN & MN
|
|
Utah
|
|
Yes
|
C - 5% of lab payment over $50 or x-ray payment over $100
|
|
C - limited to services related to primary care
|
Fee for service
|
A, B & C - See state-specific FN
|
|
Vermont
|
|
Yes
|
|
|
|
Fee for service
|
A & B - See state-specific FN
|
|
Virginia
|
|
Yes
|
|
Non-emergent outpatient diagnostic scans
|
Limits vary by service
|
Fee for service
|
CN & MN
|
|
Washington
|
|
Yes
|
|
Specified services
|
|
Fee for service
|
CN & MN
|
|
West Virginia
|
|
Yes
|
|
|
|
Fee for service, and using a percentage of Medicare payment ceilings for lab services
|
A & B
|
|
Wisconsin
|
|
Yes
|
$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
|
CN & MN
|
|
Wyoming
|
|
Yes
|
|
|
|
Fee for service
|
CN
|
|
American Samoa
|
|
Yes
|
|
|
|
|
See territory-specific FN
|
|
Guam
|
|
Yes
|
|
|
|
Fee for service
|
CN
|
|
Northern Mariana Islands
|
|
Yes
|
|
|
|
|
CN & MN - See territory-specific FN
|
|
Puerto Rico
|
|
Yes
|
|
|
Primary care physician referral required
|
Fee for service
|
CN & MN
|
|
Virgin Islands
|
|
Yes
|
|
|
Services in public health facilities only
|
Fee for service
|
CN
|
