evekhm/cms_iom_500 huggingface dataset:
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
All physicians listed are enrolled in Medicare.All interpreting physicians who are reassigning their benefits to the IDTF have the right to do so.All required CMS-855R forms have been submitted.The interpreting physicians listed are qualified to interpret the types of tests (codes) listed. In accordance with this CMS requirement (CMS Manual System, Pub. 100-08,Medicare Program Integrity Manual, Chapter 15, Section 15.5.19.3).
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
Note:The applicant cannot bill globally for interpreting physicians not listed.If an interpreting physician has been recently added or changed, the new interpreting physician must have met all of the interpreting physician requirements at the time any tests were performed.Off-Site InterpretationsIf an IDTF wants to bill for an interpretation performed by an independent practitioner off the premises of the IDTF, it must meet all instructions identified in the CMS Manual System, Pub. 100-04,Medicare Claims Processing Manual, Chapter 1, concerning purchased interpretations. In this scenario, there is no reassignment of benefits because the purchaser of the test is also considered the supplier of the test.When the technical component of a test is performed by the IDTF and the interpreting practitioner is the practitioner who ordered the test, the IDTF cannot bill for the interpretation. The interpreting practitioner must bill the interpretation since the IDTF cannot bill the interpretation when the interpreting physician is the referring physician.Purchased Diagnostic Tests and Jurisdictional PricingServices that are reimbursed under the Medicare Physician Fee Schedule (MPFS) are reimbursed by the payment locality where the service is furnished and by the zip code. Contractors must use the zip code of the location where the service was rendered to determine contractor jurisdiction over the claim and the correct payment locality.When a physician, practitioner, or supplier furnishes services in payment localities that cover more than one contractor's service area (e.g., the provider has separate offices in multiple localities and/or multiple contractors), separate claims must be submitted to the appropriate contractor for processing.Providers may not submit a global billing code on paper or electronic claims when one component of the service has been purchased. Only one service facility location (name, address and zip code) can be indicated in item 32 on the CMS-1500 form. Claims received with global services will be returned as unprocessable.Suppliers (including laboratories, physicians, and IDTFs) must bill their local contractor for all purchased diagnostic tests/interpretations, regardless of the location where the purchased service was rendered.Purchased Technical ComponentsA physician may bill for the technical component of a diagnostic test that he/she purchased from another physician, medical group or supplier. However, in order to purchase a diagnostic test from another physician, medical group, or supplier, the purchaser must perform the interpretation (professional component). Additionally, the physician or supplier that furnished the technical component must be enrolled in the Medicare program.Purchased Interpretations
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
Purchased InterpretationsA person or entity that provides diagnostic tests may submit the claim and, if assignment is accepted, receive the Part B payment for diagnostic test interpretations which that person or entity purchases from an independent physician or medical group if:
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
The tests are initiated by a physician or medical group which is independent of the person or entity providing the tests and of the physician or medical group providing the interpretations;The physician or medical group providing the interpretations does not see the patient;The purchaser (or employee, partner, or owner of the purchaser) performs the technical component of the test. The interpreting physician must be enrolled in the Medicare program. No formal reassignment is necessary; ANDThe purchaser must keep on file the name, the provider identification number and address of the interpreting physician.
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
Note:This does not remove the requirement that when an entity either purchases an interpretation or a test, they must perform the other component in order to be paid for the purchased component.In order to price claims correctly and apply purchase price limitations, global billing is not acceptable for claims received on the Form CMS-1500 or on the ANSI X12N 837 electronic format. Each component must be billed as a separate line item (or on a separate claim).Suppliers (including laboratories, physicians, and IDTFs) must submit claims for all purchased diagnostic tests/interpretations to their local contractor, regardless of the location where the purchased service was furnished.Additional Services/SuppliesAdditional services/items (e.g., radiopharmaceutical agents, special contrast agents, medications, etc.) related to, or generally considered required for, performing a diagnostic test are also payable to an IDTF if they are commonly separately reimbursed to a physician in a physicians office setting.An IDTF can bill these practitioner services when they are performed by a qualified practitioner in accordance with coverage, payment, and general billing rules, and in accordance with the reassignment of benefit and purchased test rules.These additional services/items which are necessary for the performance of specific diagnostic tests may 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. 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.However, an IDTF is not allowed to bill for surgical procedures that are clearly not related to or required for a diagnostic test.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.JW and JZ ModifiersWhen billing for Part B drugs and biologicals (except those provided under a competitive acquisition program [CAP]), the use of the JW modifier to identify unused drugs or biologicals from single use vials or single use packages that are appropriately discarded is required. The discarded amount shall be billed on a separate claim line using the JW modifier. Providers are required to document the discarded drug or biological in the patients medical record.
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
Any amount wasted must be clearly documented in the medical record and should include the date and time, amount of medication wasted, and the reason for the wastage.The use of the JZ modifier (attesting that there were no discarded amounts) is required on claims to report there are no discarded amounts of unused drugs or biologicals from single use vials or single use packages.Claims for drugs separately payable under Medicare Part B from single-dose containers are required to report either the JW or JZ modifier, to identify any discarded amounts or to attest that there are no discarded amounts, respectively.
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
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).
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
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 Procedures01= Procedure must be performed under the general supervision of a physician.02= Procedure must be performed under the direct supervision of a physician.03= Procedure must be performed under the personal supervision of a physician. (Diagnostic imaging procedures performed by a Registered Radiologist Assistant (RRA) who is certified and registered by The American Registry of Radiologic Technologists (ARRT) or a Radiology Practitioner Assistant (RPA) who is certified by the Certification Board for Radiology Practitioner Assistants (CBRPA) and is authorized to furnish the procedure under state law, may be performed under direct supervision).04= Physician 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.05= Physician supervision policy does not apply when procedure is furnished by a qualified audiologist; otherwise must be performed under the general supervision of a physician.06= Procedure 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.21= Procedure 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.22= May be performed by a technician with on-line real-time contact with a physician.66= May be personally performed by a physician or by a PT with ABPTS certification and certification in this specific procedure.6A= Supervision 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.77= 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).
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
7A= Supervision 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.09= Concept does not apply.*The provider is responsible for adhering to applicable CMS regulations for diagnostic test supervision.The level of physician supervision required for diagnostic procedures can be found in the Medicare Physician Fee Schedule Database (MPFSDB).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.
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
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 Surgeon
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
1908409Board 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.-R2736909
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
2524609Board 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 Staff5172802
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
5172602Board 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* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R6230209Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R6230309Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R6230409Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R6230509
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
6230409Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R6230509Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R7001009Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty CertificationState License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R7001503Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty CertificationState License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R7003001Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty CertificationState License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R7010001Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty CertificationState License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R7011001Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty CertificationState License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R7012001Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty CertificationState License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R7013001Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty CertificationState License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R7013401Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty CertificationState License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R7014001