Article - Independent Diagnostic Testing Facilities- physician supervision and technician requirements (A54953)

CMS National Coverage PolicyN/AArticle TextThis article is a list of diagnostic services that may be performed in an Independent Diagnostic Testing Facilities (IDTF) provided they have the appropriate physician supervision and technician requirements. The CPT codes in this document do not imply coverage of the procedure. All of the procedure codes are subject to Medicare rules and regulations, applicable Local Coverage Decisions (LCDs), and medical necessity.National credentialing bodies must be a member of the National Organization for Competency Assurance (NOCA) or certified by the Commission for Certifying Agencies (NCCA) which is the accreditation body of NOCA. In the absence of a National Credentialing Body, the Contractor has the discretion to approve educational requirements or other certifications. For example, we are allowing technicians who are certified by Cardiovascular Credentialing International (CCI) for cardiac monitoring services since there is no agency for those services that is recognized by NOCA or NCCA.Supervising physicians must be board eligible or board certified. An IDTF wishing to add a supervising physician to their file that is not of the specialty listed in the appendix may send in additional information outlining their qualifications such as additional training or education to the enrollment department. The information will be reviewed by the medical staff.Section 135(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) amended section 1834(e) of the Social Security Act and required the Secretary to designate organizations to accredit suppliers, including but not limited to physicians, non-physician practitioners and Independent Diagnostic Testing Facilities, that furnish the technical component (TC) of advanced diagnostic imaging services.MIPPA specifically defines advanced diagnostic imaging procedures as including diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET). In order to furnish the TC of advanced diagnostic imaging services for Medicare beneficiaries the suppliers must be accredited.The Centers for Medicare & Medicaid Services (CMS) approved four national accreditation organizations to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures:American College of Radiology (ACR)Intersocietal Accreditation Commission (IAC)RadSiteThe Joint Commission (TJC)All accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff. To obtain additional information about the accreditation process, please contact the accreditation organizations shown above.SuppliesCertain items (e.g., radiopharmaceutical agents, special contrast agents, medications, etc.) or services that are necessary for the performance of specific diagnostic tests may also be billed by an IDTF if approval is granted by the Contractor for the IDTF to bill for the specific test(s) that require such items/services. The items or services may not be listed on the table. For example, some procedures require an injection of a joint for arthrography and would be allowed if the procedure is integral to the diagnostic test the IDTF is permitted to perform.At the time that the IDTF requests Contractor approval to perform the tests, the IDTF must identify all such items/services that it intends to bill in conjunction with specific tests. Each IDTF will have a specific and unique list of HCPCS codes for which it can be paid. It is the responsibility of the IDTF to obtain Contractor approval to bill each HCPCS code that it intends to bill.Unlisted procedure codes are not included in the table below. Providers will need to send in a written request explaining the procedure they are performing. If the Contractor Medical Director (CMD) determines it to be an appropriate diagnostic procedure that can be safely performed in an IDTF, it will be added to the providers file.A procedure code that includes a diagnostic and/or therapeutic procedure may be allowed in an IDTF provided the service performed is diagnostic.The level of supervision listed on the database must be provided by one of the physicians listed as a supervising physician in the table below. The numeric diagnostic supervision levels assigned to each CPT or HCPCS code are found on the Medicare Physician Fee Schedule Database (MPFSDB).These are abbreviated code descriptions of the procedures that may be allowed in an IDTF. Providers should consult a CPT book for the complete code description of the procedures they are performing/billing.CPT/ HCPCS CodesDescriptionSupervising Physician Qualification RequirementsTechnician Qualification27369Njx cntrst kne arthg/ct/mriRadiologist or Orthopedic SurgeonPhysician Only Service51798Us urine capacity measureUrologist or RadiologistUrology or OB/GYN Personally Trained Staff; CRT-R70010Contrast x-ray of brainRadiologistPhysician Only Service70015Contrast x-ray of brainRadiologistPhysician Only Service70030X-ray eye for foreign bodyRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70100X-ray exam of jaw<4viewsRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70110X-ray exam of jaw 4/>viewsRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70120X-ray exam of mastoidsRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70130X-ray exam of mastoidsRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70134X-ray exam of middle earRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70140X-ray exam of facial bonesRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70150X-ray exam of facial bonesRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70160X-ray exam of nasal bonesRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70170X-ray exam of tear ductRadiologistPhysician only service70190X-ray exam of eye socketsRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70200X-ray exam of eye socketsRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70210X-ray exam of sinusesRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70220X-ray exam of sinusesRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70240X-ray exam, pituitary saddleRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70250X-ray exam of skullRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70260X-ray exam of skullRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70300X-ray exam of teethRadiologist/DDS/ Maxofacial SurgeonCertified Radiologic Technologist (ARRT:R.T.-R)70310X-ray exam of teethRadiologist/DDS/ Maxofacial SurgeonCertified Radiologic Technologist (ARRT:R.T.-R)70320Full mouth x-ray of teethRadiologist/DDS/ Maxofacial SurgeonCertified Radiologic Technologist (ARRT:R.T.-R)70328X-ray exam of jaw jointRadiologist/DDS/ Maxofacial SurgeonCertified Radiologic Technologist (ARRT:R.T.-R)70330X-ray exam of jaw jointsRadiologist/DDS/ Maxofacial SurgeonCertified Radiologic Technologist (ARRT:R.T.-R)70332X-ray exam of jaw jointRadiologist/DDS/ Maxofacial SurgeonCertified Radiologic Technologist (ARRT:R.T.-R)70336Magnetic image, jaw jointRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70350X-ray head for orthodontiaRadiologist/DDS/ Maxofacial SurgeonCertified Radiologic Technologist (ARRT:R.T.-R)70355Panoramic x-ray of jawsRadiologist/DDS/ Maxofacial SurgeonCertified Radiologic Technologist (ARRT:R.T.-R)70360X-ray exam of neckRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70370Throat x-ray & fluoroscopyRadiologistPhysician Only Service70371Speech evaluation, complexRadiologistPhysician Only Service70380X-ray exam of salivary glandRadiologistCertified Radiologic Technologist (ARRT:R.T.-R)70390X-ray exam of salivary ductRadiologistPhysician Only Service70450CT head/brain w/o dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70460CT head/brain w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70470CT head/brain w/o & w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70480CT orbit/ear/fossa w/o dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70481CT orbit/ear/fossa w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70482CT orbit/ear/fossa w/o & w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70486CT maxillofacial w/o dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70487CT maxillofacial w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70488CT maxillofacial w/o & w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70490CT soft tissue neck w/o dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70491CT soft tissue neck w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70492CT sft tsue nck w/o & w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70496CT angiography, headRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70498CT angiography, neckRadiologistCertified Radiologic Technologist (ARRT:R.T.-CT)70540MRI orbit/face/neck w/o dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70542MRI orbit/face/neck w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70543MRI orbt/fac/nck w/o & w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70544MR angiography head w/o dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RTMR70545MR angiography head w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70546MR angiograph head w/o & w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70547MR angiography neck w/o dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70548MR angiography neck w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70549MR angiograph neck w/o&w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70551MRI brain w/o dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70552MRI brain w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70553MRI brain w/o & w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70554FMRI brain by techRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70555FMRI brain by phys/psychRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70557MRI brain w/o dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR70558MRI brain w/dyeRadiologistCertified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR