FLORIDA - MEDICAL STANDARDS GOVERNING SCREENING AND DIAGNOSTIC MEDICAL TESTING OFFICES

1. What is a diagnostic test?

Any medical service utilizing biomechanical, neurological, neurodiagnostic, radiological, vascular or any means, other than bioanalysis, intended to assist in establishing a medical diagnosis, for the purpose of recommending a course of treatment for the tested patient to be implemented by the treating practitioner or by the consultant. Diagnostic images services means magnetic resonance imaging, nuclear medicine, angiography, arteriography, computed tomography, positron emission tomography, digital vascular imaging, bronchography, lymphangiography, splenography, ultrasound, EEG, EKG, nerve conduction studies and evoked potentials.

F.S.A. § 456.063

Physicians who order, perform, or interpret diagnostic imaging tests or procedures are responsible for the appropriateness and quality of the non-invasive diagnostic procedure, interpretation of the results, diagnosis, and either maintenance of medical records or provision of the results of the test to the referring physician.

64 FL ADC 64B8-9.010

3. What are the penalties for unnecessary diagnostic testing?

No health care provider shall order, provide, or administer unnecessary diagnostic tests, which are not reasonably calculated to assist the health care provider in arriving at a diagnosis and treatment of a patient's condition. Violations shall be grounds for disciplinary action. Any person who prevails in a suit brought against a health care provider shall recover reasonable attorney's fees and costs.

F.S.A. § 766.111

4. Which diagnostic tests are deemed not to be medically necessary for use in the diagnosis and treatment of persons sustaining bodily injury covered by personal injury protection benefits?

(1) Spinal ultrasound, also known as sonography, ultrasonography, and echography, is deemed not to be medically necessary for use in the diagnosis and treatment of persons sustaining bodily injury covered by personal injury protection benefits.

(2) Somatosensory Evoked Potential is deemed not to be medically necessary for use in the diagnosis of radiculopathy or distal nerve entrapment when treating persons sustaining bodily injury covered by personal injury benefits; and

(3) Dermatomal Evoked Potential is deemed not to be medically necessary for use in the diagnosis and treatment of persons sustaining bodily injury covered by personal injury protection benefits.

64 FL ADC 64B-3.004

5. Is Surface EMG deemed medically necessary for the diagnosis and treatment of persons sustaining bodily injury covered by personal injury protection benefits?

Yes. Originally deemed not to be medically necessary, Florida courts have now held that this test does have medical value as a diagnostic tool.

Department of Health v. Merritt, 919 So. 2d 561 (2006)

6. Do chiropractic physicians have the right of access to diagnostic reports?

Each hospital shall set standards and procedures which provide for reasonable access by licensed chiropractic physicians to the reports of diagnostic x-rays and laboratory tests of licensed facilities, subject to the same standards and procedures as other licensed physicians. However, this does not require a licensed facility to grant staff privileges to a chiropractic physician.

F.S.A. § 395.0195

7. What are the insurance coverage regulations for mammograms?

(1) A group, blanket, or franchise accident or health insurance policy must provide coverage for at least the following:

(a) A baseline mammogram for any woman who is 35 years of age or older, but younger than 40 years of age;

(b) A mammogram every 2 years for any woman who is 40 years of age or older, but younger than 50 years of age, or more frequently based on the patient's physician's recommendation;

(c) A mammogram every year for any woman who is 50 years of age or older; and

(d) One or more mammograms a year, based upon a physician's recommendation, for any woman who is at risk for breast cancer because of a personal or family history of breast cancer, because of having a history of biopsy-proven benign breast disease, because of having a mother, sister, or daughter who has or has had breast cancer, or because a woman has not given birth before the age of 30.

F.S.A. § 627.6613; F.S.A. § 627.6418

Copyright Kern Augustine Conroy and Schoppmann, P.C. Used with permission.