How do the Medical Treatment Guidelines affect radiology facilities?
Imaging studies performed to the neck, back, knee, and shoulder will be governed by the Medical Treatment Guidelines effective December 1, 2010. This means that if the study is not consistent with the Guidelines, then the insurance carrier or self-insured employer is not responsible for payment, and the facility cannot bill the claimant. • How is a radiologist with a free standing diagnostic facility or a hospital, who relies on the treating physician’s history and physical examination, supposed to know if the patient’s treating physician has followed the appropriate Medical Treatment Guideline protocols prior to requesting the radiology exam being ordered? The radiologist may wish to contact the treating medical provider and ask if he or she has ordered the study consistent with the Medical Treatment Guidelines for the body part in question. The radiologist may also contact the insurance carrier or self-insured employer to determine if the imaging study is consistent with the Guidelin
