(Medicare Claims Processing Manual)

The IHS providers may choose to purchase or otherwise contract for teleradiology interpretation from non- IHS practitioners.  Two options are available for payment for these services.   (1) Contractual Reassignment -  Under this provision, non- IHS physicians can reassign their benefit s to the IHS hospital where the technical component is performed.  Non- IHS practitioners providing these services shall enroll with the designated A/B MAC contractor for IHS and complete a Form CMS -855-R form for each IHS hospital performing the test.  Bec ause of IHS status, state licensure and location of the physicians is not an issue and the designated A/B MAC contractor shall make payment based on the Medicare locality in which services are rendered in accordance with current jurisdictional pricing guid elines (see 80.2, paragraph 6 of this Chapter).   Purchased Test - The purchased test method is available for all purchased diagnostic tests including radiology, and the requirements are found in Chapter 1.  Payment for teleradiology interpretations under the purchased test option does not require non- IHS physicians enrollment with the designated A/B MAC contractor for IHS.  All general jurisdictional and pricing rules apply for payment for these services.  Transmittals Issued for this Chapter   Rev #  Issue  Date  Subject  Impl Date  CR#  R11427CP  05/20/2022  Claims Processing Manual  Update - Pub. 100-04 for Elimination of Certificates of Medical Necessity (CMNs) and Durable Medical Equipment Forms (DIFs)   01/03/2023  12734  R11414CP  05/12/2022  Claims Processing Manual Update - Pub. 100-04 for Elimination of Certificates of Medical Necessity (CMNs) and Durable Medical Equipment Forms (DIFs) -  Rescinded and replaced by Transmittal 11427   06/13/2022  12734  R3897CP  10/27/2017  Pulmonary Rehabilitation (PR) Services Addition to Chapter 19, Indian Health Services (IHS)   04/02/2018  10276  R3049CP  08/25/2014  Update to Pub. 100 -04, Chapter 19 to Provide Language -Only Changes for ICD -10 and ASC X12  09/23/2014  8646  R2895CP  03/07/2014  Update to Pub. 100 -04, Chapter 19 to Provide Language -Only Changes for ICD -10 and ASC X12  Rescinded and replaced by Transmittal 3049  10/01/2014  8646  R2102CP  11/19/2010  Systems Changes Necessary to Implement Technical Correction Related to Critical Access Hospital Services, Section 3128 of the Affordable Care Act, Pub. 118 -148 04/04/2011  7219  R2075CP  10/28/2010  Implementation of Section 2902 of the Patient Protection and Affordable Care Act (the Affordable Care Act) for Indian Health Service (HIS) Part B Services and All Inclusive Rate (AIR) Billing for Return Visits  01/28/2011  6908  R1957CP  04/28/2010  Update to the HCPCS Codes for Payment of Surgical Dressings to Indian Health Service (HIS) Providers  10/04/2010  6909  R1776CP  07/24/2009  Telehealth Services in Indian Health Service (HIS) or Tribal Providers  01/042010  6493  Rev #  Issue  Date  Subject  Impl Date  CR#  R1643CP  12/05/2008  Indian Health Service (IHS) Provider Payment to Non-IHS Physicians for Teleradiology Interpretations  03/09/2009  6162  R1511CP  05/23/2008  Indian Health Service (HIS) Hospital Payment for Calendar Year 2008  06/23/2008  6063  R1446CP  02/08/2008  Update to Common Working File (CWF) Edits 7284 and 7548  07/07/2008  5907  R1325CP  08/29/2007  Testing and Implementation of 2008 Ambulatory Surgical Center (ASC) Payment System Changes  01/07/2008  5680  R1308CP  07/20/2007  Testing and Implementation of 2008 Ambulatory Surgical Center (ASC) Payment System Changes  Replaced by Transmittal 1325  01/07/2008  5680  R1040CP  08/25/2006  Clarifications and Additions to Chapter 19, Indian Health Services (IHS) - Replaces Rev. 1027  09/11/2006  5230  R1027CP  08/11/2006  Clarifications and Additions to Chapter 19, Indian Health Services (IHS) - Replaced by Rev. 1040  09/11/2006  5230  R706CP  10/07/2005  Payment Methodology for Rehabili tation Services in IHS/Tribally Owned and/or Operated Hospitals and Hospital -Based Facilities  01/03/2006  3934  R681CP  09/16/2005  Guidelines For  Payment of Vaccines (Pneumococcal Pneumonia Virus (PPV), Influenza Virus, And Hepatitis B Virus) and Their Administration Provided By Indian Health Service (IHS) Tribally Owned and/or Operated Hospitals and Hospital Based Facilities  01/03/2006  3967  R633CP  08/03/2005  Guidelines For Payment of Vaccines (Pneumococcal Pneumonia Virus (PPV), Influenza Virus, And Hepatitis B Virus) and Their Administration Provided By Indian Health Service (IHS) Tribally Owned and/or Operated Hospitals and Hospital Based Facilities  01/03/2006  3967  R611CP  07/22/2005  Payment Methodology for Rehabilitation Services in IHS/Tribally Owned and/or 01/03/2006  3934  Rev #  Issue  Date  Subject  Impl Date  CR#  Operated Hospitals and Hospital -Based Facilities  R461CP  02/04/2005  Processing Durable Med ical Equipment (DME) Orthotics, Prosthetics, Drugs, and Surgical Dressing Claims for Indian Health Services (IHS) and Tribally Owned and Operated Hospitals for Hospital Based Facilities including Critical Access Hospitals (CAHs)  07/05/2005  3674  R430CP  01/14/2005  Mandatory Assignment for MMA 630 Claims  07/05/2005  3587  R241CP  07/23/2004  Expansion of the s cope of items and services for which payment may be made to IHS facilities and suppliers  01/03/2005  3288  R201CP  06/10/2004  Initial Publication of Chapter  Not Applicable  3302  Back to top of Chapter