Article - Billing and Coding: Independent Diagnostic Testing Facilities (IDTF) (A58559)

CMS National Coverage PolicyCMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 80.2 Psychological and Neuropsychological Tests and 80.6 Requirements for Ordering and Following Orders for Diagnostic TestsCMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 1, 30.2 Assignment of Providers Right to PaymentCMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 35, Independent Diagnostic Testing Facility (IDTF)Title XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.Title XVIII of the Social Security Act, 1861(aa)(6) NPs and CNSs perform tests in collaboration with a physician.42 CFR 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions42 CFR 410.33Independent diagnostic testing facilityArticle TextThis article provides information regarding CPT/HCPCS codes that describe diagnostic procedures (and some materials required to perform the diagnostic procedures, i.e., radioactive tracers) that may be performed in an independent diagnostic testing facility (IDTF).Coding GuidelinesIn order for an IDTF to be reimbursed by Medicare for any procedure or material included in this article, that specific IDTF must be credentialed and approved by Palmetto GBA provider enrollment to bill for that specific service when provided to a Medicare beneficiary.The information in this article may not be all-inclusive and may be subject to change as CPT/HCPCS codes are updated. The codes included in this article are based on the latest coding updates. The effective date of this article is the date of the most recent update.With these updates certain codes may be deleted but will still be appropriate for billing up to 1 year after the procedure date. A listing of these codes that may still be valid are located in theOther Coding Informationsection of this article.The listing of a procedure code does not guarantee that Medicare will reimburse the service. All services are subject to Medicare medical necessity and coverage policies, including National Coverage Decisions, Local Coverage Decisions, statutory exclusions and instructions in interpretive manuals.It is not appropriate to bill Medicare for services that are not covered as if they are covered. When billing for non-covered services, use the appropriate modifier.Additional Services/SuppliesAdditional services/items (e.g., radiopharmaceutical agents, special contrast agents, medications, etc.) are considered supplies and are also payable to an IDTF if they are commonly separately reimbursed to a physician in a physicians office setting. They are not listed in this article, in that if the test is payable, the supplies will be also.Physician Supervision of Diagnostic ProceduresThe following list defines the numeric level of physician supervision for diagnostic procedures assigned to each CPT/HCPCS code and is located in theMedicare Physician Fee Schedule Database (MPFSDB).1 = General supervision of a physician2 = Direct supervision of a physician3 = Personal supervision of a physician4 = Physician supervision does not apply if performed by a qualified independent psychologist or a clinical psychologist; otherwise general supervision of a physician is required5 = Physician supervision does not apply if performed by a qualified audiologist; otherwise general supervision of a physician is required6 = Must be personally performed by a physician or by a physical therapist (PT) who is certified by the American Board of Physical Therapy Specialties (ABPTS) as a qualified electrophysiologic clinical specialist and is permitted to provide the service under state law66 = May be performed by a physician or a physical therapist with ABPTS certification and certification in this specific procedure6A = Supervision standards for level 66 apply; in addition, the PT with ABPTS certification may supervise another PT, but only the PT with ABPTS certification may bill21 = Procedure may be performed by a technician with certification under general supervision of a physician; otherwise must be performed under the direct supervision of a physician22 = May be performed by a technician with on-line real-time contact with a physician77 = Procedure must be performed by a PT with ABPTS certification (TC & PC) or by a PT without certification under direct supervision of a physician (TC & PC), or by a technician with certification under general supervision of a physician (TC only; PC always physician)7A = Must be personally performed by a physical therapist (PT) who is certified by the American Board of Physical Therapy Specialties (ABPTS) or by a PT without certification under direct supervision of a physician, or by a technician with certification under general supervision; in addition, the PT with ABPTS certification may supervise another PT, but only the PT with ABPTS certification may bill9 = 26 /TC indicator not applicable - concept of a professional/technical component does not applyQualification requirements: IDTF Supervising PhysicianLicensed to practice in the state(s) in which the diagnostic tests he or she supervises will be performedEnrolled in MedicareMeets the proficiency standards for any tests he or she is supervisingNot currently excluded or barredProvides general supervision for no more than three IDTF sitesQualification requirements: IDTF Interpreting PhysicianLicensed to practice in the state(s) in which the diagnostic tests he or she interprets will be performedEnrolled in MedicareNot currently excluded or barredQualified to interpret the types of tests (codes) listed in the enrollment applicationQualification requirements: IDTF TechnicianMeets the licensure and/or certification standards of the state in which tests are performed at the time of the IDTFs enrollment and/or at the time any tests were performedQualified to perform the types of tests (codes) listed in the enrollment applicationNote:*American Board of Medical Specialties (ABMS), American Osteopathic Association (AOA), or other subspecialtyCPT/HCPCS CodesSupervising Physician QualificationsTechnician QualificationsG0106Board Certified* GastroenterologistGeneral Radiographer, ARRT: R.T.-N or NMTCB:CNMTG0120Board Certified* RadiologistGeneral Radiographer, ARRT: R.T.G0130Board Certified* Radiologist or Orthopaedic SurgeonGeneral Radiographer, ARRT: R.T.-BDG0279Board Certified* RadiologistGeneral Radiographer, ARRT: R.T.-M (Facility must be FDA certified to perform mammography)G0288Board Certified* Radiologist or Cardiovascular SurgeonGeneral Radiographer, ARRT: R.T., ARDMS: RDCS or CCI: RCSG0398Board Certified* Physician with (ABSM, ABFM, ABIM or ABOto)BRPT: RPSGT, ABRET: R. EEG T. (Polysomnography), CRT: SDS, or RRT: SDSG0399Board Certified* Physician with (ABSM, ABFM, ABIM or ABOto)BRPT: RPSGT, ABRET: R. EEG T. (Polysomnography), CRT: SDS, or RRT: SDSG0400Board Certified* Physician with (ABSM, ABFM, ABIM or ABOto)BRPT: RPSGT, ABRET: R. EEG T. (Polysomnography), CRT: SDS, or RRT: SDSG0500Board Certified* Gastroenterologist or AnesthesiologistN/AG2010Board Certified* RadiologistN/A0568TBoard Certified* OB/GYNARDMS: Sonographer0598TBoard Certified* PhysicianN/A0599TBoard Certified* PhysicianN/A0602TBoard Certified* Nephrologist or UrologistN/A0603TBoard Certified* Nephrologist or UrologistN/A0604TBoard Certified* Ophthalmologist or OptometristN/A0605TBoard Certified* Ophthalmologist or OptometristN/A0606TBoard Certified* Ophthalmologist or OptometristN/A0607TBoard Certified* CardiologistARDMS: RDCS or CCI: RCS0608TBoard Certified* CardiologistARDMS: RDCS or CCI: RCS0609TBoard Certified* Radiologist or Neurologist with (ASN or UCNS)ARRT: MR or ARMRIT: MRI0610TBoard Certified* Radiologist or Neurologist with (ASN or UCNS)ARRT: MR or ARMRIT: MRI0611TBoard Certified* Radiologist or Neurologist with (ASN or UCNS)ARRT: MR or ARMRIT: MRI0615TBoard Certified* Radiologist, Neurologist with (ASN or UCNS) or PhysicianARRT: MR or ARMRIT: MRI0633TBoard Certified* RadiologistARRT: CT0634TBoard Certified* RadiologistARRT: CT0635TBoard Certified* RadiologistARRT: CT0636TBoard Certified* RadiologistARRT: CT0637TBoard Certified* RadiologistARRT: CT0638TBoard Certified* RadiologistARRT: CT0648TBoard Certified* RadiologistN/A0650TBoard Certified* CardiologistARDMS: RDCS or CCI: RCS0651TBoard Certified* GatroenterologistN/A0652TBoard Certified* GatroenterologistN/A0658TBoard Certified* DermatologistN/A0659TBoard Certified* CardiologistN/A0689TBoard Certified* RadiologistN/A0690TBoard Certified* RadiologistN/A0691TBoard Certified* RadiologistN/A0693TBoard Certified* RadiologistN/A0697TBoard Certified* RadiologistN/A0698TBoard Certified* RadiologistN/A0721TBoard Certified* RadiologistN/A0722TBoard Certified* RadiologistN/A0723TBoard Certified* RadiologistN/A0724TBoard Certified* RadiologistN/A10004Board Certified* RadiologistGeneral Radiographer, ARRT10005Board Certified* PhysicianARDMS: Sonographer10006Board Certified* PhysicianARDMS: Sonographer10007Board Certified* PhysicianARRT: Fluoroscopy10008Board Certified* PhysicianARRT: Fluoroscopy10009Board Certified* PhysicianARRT: CT10010Board Certified* PhysicianARRT: CT10011Board Certified* PhysicianARRT: MRI10012Board Certified* PhysicianARRT: MRI11102Board Certified* DermatologyN/A11103Board Certified* DermatologyN/A11104Board Certified* DermatologyN/A11105Board Certified* DermatologyN/A11106Board Certified* DermatologyN/A11107Board Certified* DermatologyN/A19000Board Certified* PhysicianN/A19001Board Certified* PhysicianN/A19030Board Certified* PhysicianN/A19081Board Certified* Radiologist or SurgeonGeneral Radiographer, ARRT: R.T.-M, ARDMS: RDMS or RT BS, ARRT: MR or ARMRIT: MRI19082Board Certified* Radiologist or SurgeonGeneral Radiographer, ARRT: R.T.-M, ARDMS: RDMS or RT BS, ARRT: MR or ARMRIT: MRI19083Board Certified* Radiologist or SurgeonGeneral Radiographer, ARRT: R.T.-R or ARRT: R.T.-M, ARDMS: RDMS or RT BS, ARRT: MR or ARMRIT: MRI19084Board Certified* Radiologist or SurgeonGeneral Radiographer, ARRT: R.T.-R or ARRT: R.T.-M, ARDMS: RDMS or RT BS, ARRT: MR or ARMRIT: MRI19085Board Certified* Radiologist or SurgeonGeneral Radiographer, ARRT: R.T.-M, ARDMS: RDMS or RT BS, ARRT: MR or ARMRIT: MRI19086Board Certified* Radiologist or SurgeonGeneral Radiographer, ARRT: R.T.-M, ARDMS: RDMS or RT BS, ARRT: MR or ARMRIT: MRI23350Board Certified* Radiologist or OrthopedistGeneral Radiographer, ARRT: R.T.-R24220Board Certified* RadiologistARRT: R.T.-R25246Board Certified* RadiologistARRT: R.T.-R27093Board Certified* RadiologistARRT: R.T.-R27095Board Certified* RadiologistARRT: R.T.-R27096Board Certified* Radiologist, Orthopedist or NeurologistN/A27369Board Certified* Radiologist, Orthopaedic Surgeon or PodiatristGeneral Radiographer, Medical Physicist, ARRT: R.T.-CT or R.T.-MR or ARMRIT: MRI27648Board Certified* RadiologistARRT: R.T.-R31253Board Certified* OtolaryngologistN/A36005Board Certified* RadiologistARRT: R.T.-R38505Board Certified* Radiologist or General PhysicianN/A