Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)

The JW and JZ modifier policy does not apply for drugs that are not separately payable, such as packaged OPPS or ASC drugs, or drugs administered in the FQHC or RHC setting.The JW and JZ modifiers do not apply to drugs assigned status indicator N (Items and Services Packaged into APC Rates) under the OPPS. Similarly, the JW and JZ modifiers do not apply to drugs assigned payment indicator N1 (ASC).Documentation RequirementsAll documentation must be maintained in the patient's medical record and made available to the contractor upon request.Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.Medical record documentation maintained by the IDTF must include the information listed below and be available upon request:Written order from the treating physician, andHard copy documentation of the test results and interpretation.The IDTF must maintain documentation to demonstrate the required physician supervision requirements were met. Also, the IDTF must maintain documentation of sufficient physician resources during all hours of operation to assure that the required physician supervision is furnished.Multi-state entities must maintain evidence that supervising physicians are licensed to practice in the state(s) where the diagnostic tests are performed and the technicians performing the diagnostic test(s) are credentialed appropriately in each state in which services are performed in accordance with requirements outlined in this article.Documentation maintained by the IDTF must support that the personnel performing the diagnostic test(s) have the training and proficiency as evidenced by current licensure or certification as outlined in this article. This documentation must contain verification by the supervising physician(s).Physician Supervision of Diagnostic ProceduresSupervision LevelDescription01Procedure must be performed under the general supervision of a physician.02Procedure must be performed under the direct supervision of a physician.03Procedure must be performed under the personal supervision of a physician.04Physician supervision policy does not apply when procedure is furnished by a qualified, independent psychologist or a clinical psychologist. Otherwise the procedure must be performed under the general supervision of a physician.05Physician supervision policy does not apply when procedure is furnished by a qualified audiologist; otherwise must be performed under the general supervision of a physician.06Procedure must be personally performed by a physician or a Physical Therapist (PT) who is certified by the American Board of Physical Therapy Specialties (ABPTS) as a qualified electrophysiological clinical specialist and is permitted to provide the procedure under State law. Procedure may also be performed by a PT with ABPTS certification without physician supervision.21Procedure may be performed by a technician with certification under general supervision of a physician. Otherwise the procedure must be performed under direct supervision of a physician. Procedure may also be performed by a PT with ABPTS certification without physician supervision.22May be performed by a technician with on-line real-time contact with a physician.66May be personally performed by a physician or by a PT with ABPTS certification and certification in this specific procedure.6ASupervision standards for level 66 apply; in addition, the PT with ABPTS certification may personally supervise another PT, but only the PT with ABPTS certification may bill.77Procedure 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).7ASupervision standards for level 77 apply; in addition, the PT with ABPTS certification may personally supervise another PT, but only the PT with ABPTS certification may bill.09Concept does not apply.The provider is responsible for adhering to applicable CMS regulations for diagnostic test supervision.Credentialing MatrixThe following table reflects CMS supervision requirements, which describes the levels of physician supervision required for furnishing the technical component of diagnostic tests for Medicare beneficiaries who are not a hospital inpatient or outpatient.*American Board of Medical Specialty (ABMS), American Board of Nuclear Medicine (ABNM), American Board of Physical Medicine and Rehabilitation (ABPMR), American Board of Psychiatry and Neurology (ABPN), American Osteopathic Association (AOA), or subspecialty certification.CPT/HCPCS CODESLEVEL OF PHYSICIAN SUPERVISIONSUPERVISING PHYSICIAN QUALIFICATION REQUIREMENTSTECHNICIAN QUALIFICATION REQUIREMENTS1000509Board Certified* RadiologistCredentialed by ARRT in ultrasound1000609Board Certified* RadiologistCredentialed by ARRT in ultrasound1000709Board Certified* RadiologistCredentialed by ARRT in fluoroscopy1000809Board Certified* RadiologistCredentialed by ARRT in fluoroscopy1000909Board Certified* RadiologistCredentialed by ARRT in CT1001009Board Certified* RadiologistCredentialed by ARRT in CT1001109Board Certified* RadiologistCredentialed by ARRT in MRI1001209Board Certified* RadiologistCredentialed by ARRT in MRI1002109Board Certified* PhysicianN/A1900009Board Certified* Radiologist or SurgeonGeneral Radiographer or Credentialed by ARRT: R.T.-R or ARRT: R.T.-M or ARDMS: RDMS or RT BS or ARRT: MR or ARMRIT: MRI1900109Board Certified* Radiologist or SurgeonGeneral Radiographer or Credentialed by ARRT: R.T.-R or ARRT: R.T.-M or ARDMS: RDMS or RT BS or ARRT: MR or ARMRIT: MRI1908109Board Certified* Radiologist or SurgeonState License: General Radiographer or Credentialed by ARRT: R.T.-R or ARRT: R.T.-M or ARDMS: RDMS or RT BS or ARRT: MR or ARMRIT: MRI1908209Board Certified* Radiologist or SurgeonState License: General Radiographer or Credentialed by ARRT: R.T.-R or ARRT: R.T.-M or ARDMS: RDMS or RT BS or ARRT: MR or ARMRIT: MRI1908309Board Certified* Radiologist or SurgeonState License: General Radiographer or Credentialed by ARRT: R.T.-R or ARRT: R.T.-M or ARDMS: RDMS or RT BS or ARRT: MR or ARMRIT: MRI1908409Board Certified* Radiologist or SurgeonState License: General Radiographer or Credentialed by ARRT: R.T.-R or ARRT: R.T.-M or ARDMS: RDMS or RT BS or ARRT: MR or ARMRIT: MRI1908509Board Certified* Radiologist or SurgeonState License: General Radiographer or Credentialed by ARRT: R.T.-R or ARRT: R.T.-M or ARDMS: RDMS or RT BS or ARRT: MR or ARMRIT: MRI1908609Board Certified* Radiologist or SurgeonState License: General Radiographer or Credentialed by ARRT: R.T.-R or ARRT: R.T.-M or ARDMS: RDMS or RT BS or ARRT: MR or ARMRIT: MRI1928109Board Certified* Radiologist or SurgeonGeneral Radiographer or Credentialed by ARRT: R.T.-R or ARRT: R.T.-M or ARDMS: RDMS or RT BS or ARRT: MR or ARMRIT: MRI1928309Board Certified* Radiologist or SurgeonGeneral Radiographer or Credentialed by ARRT: R.T.-R or ARRT: R.T.-M or ARDMS: RDMS or RT BS or ARRT: MR or ARMRIT: MRI1928509Board Certified* Radiologist or SurgeonGeneral Radiographer or Credentialed by ARRT: R.T.-R or ARRT: R.T.-M or ARDMS: RDMS or RT BS or ARRT: MR or ARMRIT: MRI2050109Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R2335009Board Certified* Radiologist or OrthopedistState License: General Radiographer or Credentialed by ARRT: R.T.-R2422009Board Certified* Radiologist or OrthopedistState License: General Radiographer or Credentialed by ARRT: R.T.-R2524609Board Certified* Radiologist or OrthopedistState License: General Radiographer or Credentialed by ARRT: R.T.-R2736909Board Certified* Radiologist or OrthopedistState License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R or ARRT: R.T.-CT or R.T.- MR or ARMRIT: MRI2764809Board Certified* Radiologist, Orthopedist or PodiatristState License: General Radiographer or Credentialed by ARRT: R.T.-R2709309Board Certified* Radiologist or OrthopedistState License: General Radiographer or Credentialed by ARRT: R.T.-R2709509Board Certified* Radiologist or OrthopedistState License: General Radiographer or Credentialed by ARRT: R.T.-R3690109Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R4255009Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R4375409Board Certified* GastroenterologistRN4375509Board Certified* GastroenterologistRN4753109Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R4753209Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R4754409Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R5160009Board Certified* Radiologist or UrologistState License: General Radiographer or Credentialed by ARRT: R.T.-R5161009Board Certified* Radiologist or UrologistState License: General Radiographer or Credentialed by ARRT: R.T.-R5172502Board Certified* UrologistUrology or OB/GYN Personally Trained Staff5172602Board Certified* UrologistUrology or OB/GYN Personally Trained Staff5172702Board Certified* UrologistUrology or OB/GYN Personally Trained Staff5172802Board Certified* UrologistUrology or OB/GYN Personally Trained Staff5172902Board Certified* UrologistUrology or OB/GYN Personally Trained Staff5173602Board Certified* UrologistUrology or OB/GYN Personally Trained Staff5174102Board Certified* UrologistUrology or OB/GYN Personally Trained Staff5178402Board Certified* Urologist, Neurologist or PhysiatristUrology or OB/GYN Personally Trained Staff5178503Board Certified* Urologist, Neurologist or PhysiatristUrology or OB/GYN Personally Trained Staff5179202Board Certified* Urologist, Neurologist or PhysiatristUrology or OB/GYN Personally Trained Staff5179702Board Certified* UrologistUrology or OB/GYN Personally Trained Staff5179809Board Certified* Urologist or RadiologistUrology or OB/GYN Personally Trained Staff or State License: General Radiographer or Credentialed by ARRT: R.T.-R5424002Board Certified* UrologistCredentialed by ARDMS: RVT or CCI: RVS5425001Board Certified* UrologistCredentialed by ARDMS: RVT or CCI: RVS5834009Board Certified* Radiologist or GynecologistCredentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S5902501Board Certified* Obstetrics/GynecologyRN6228409Board Certified* Radiologist