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May 2013 CSHCN Services Program Provider Manual

16 Diagnostic Radiology Services : Benefits, Limitations, and Authorization Requirements : X-ray and Ultrasound Procedures : Abdominal Flat Plates (AFPs) and Kidney, Ureter, and Bladder (KUB)

16.2.10.3 Abdominal Flat Plates (AFPs) and Kidney, Ureter, and Bladder (KUB)
The following procedure codes for AFPs and KUB procedures are included in the cost of the more complicated X-ray and will not be reimbursed separately:
Exception: The AFP and KUB procedures may be reimbursed separately if documentation is submitted with the claim that indicates that the results of these X-rays required more complicated X-rays.

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