evekhm/cms_iom_500 huggingface dataset:
Article - Independent Diagnostic Testing Facilities- physician supervision and technician requirements (A54953)
95867Muscle test cran nerv unilatNeurologist Physical Medicine & RehabProcedure must be performed by PT w/ ABPTS95868Muscle test cran nerve bilatNeurologist Physical Medicine & RehabProcedure must be performed by PT w/ ABPTS95869Muscle test, thor paraspinalNeurologist Physical Medicine & RehabProcedure must be performed by PT w/ ABPTS95870Muscle test, nonparaspinalNeurologist Physical Medicine & RehabProcedure must be performed by PT w/ ABPTS95872Muscle test, one fiberNeurologist Physical Medicine & RehabProcedure must be performed by PT w/ ABPTS95875Limb exercise testNeurologist Physical Medicine & Rehab NeurologistPhysician only service95885Musc tst done w/nerv tst limNeurologist Physical Medicine & RehabProcedure must be performed by PT w/ ABPTS95886Musc test done w/n test compNeurologist Physical Medicine & RehabProcedure must be performed by PT w/ ABPTS95887Musc tst done w/n tst nonextNeurologist Physical Medicine & RehabProcedure must be performed by PT w/ ABPTS95905Motor &/sens NCV testNeurologist Physical Medicine & RehabRegistered evoked potential technologist (R.EPT)95907Nvr cndj tst 1-2 studiesNeurologist Physical Medicine & RehabRegistered evoked potential technologist (R.EPT)95908Nvr cndj tst 3-4 studiesNeurologist Physical Medicine & RehabRegistered evoked potential technologist (R.EPT)95909Nvr cndj tst 5-6 studiesNeurologist Physical Medicine & RehabRegistered evoked potential technologist (R.EPT)95910Nvr cndj tst 7-8 studiesNeurologist Physical Medicine & RehabRegistered evoked potential technologist (R.EPT)95911Nvr cndj tst 9-10 studiesNeurologist Physical Medicine & RehabRegistered evoked potential technologist (R.EPT)95912Nvr cndj tst 11-12 studiesNeurologist Physical Medicine & RehabRegistered evoked potential technologist (R.EPT)
Article - Independent Diagnostic Testing Facilities- physician supervision and technician requirements (A54953)
95912Nvr cndj tst 11-12 studiesNeurologist Physical Medicine & RehabRegistered evoked potential technologist (R.EPT)95913Nvr cndj tst 13/> studiesNeurologist Physical Medicine & RehabRegistered evoked potential technologist (R.EPT)95921Autonomic parasym testingNeurologist Physical Medicine & RehabCredentialed by ABRET as R. EPT95922Autonomic testing sympathetic > 5 minutes tiltNeurologist Physical Medicine & RehabCredentialed by ABRET as R. EPT95923Sudomotor plusNeurologist Physical Medicine & RehabCredentialed by ABRET as R. EPT95924Ans parasymp & symp w/tiltNeurologist Physical Medicine & RehabCredentialed by ABRET as R. EPT95925Somatosensory testingNeurologistCredentialed by ABRET as R. EPT95926Somatosensory testingNeurologistCredentialed by ABRET as R. EPT95927Somatosensory testingNeurologistCredentialed by ABRET as R. EPT95928C motor evoked, uppr limbsNeurologistCredentialed by ABRET as R. EPT95929C motor evoked, lwr limbsNeurologistCredentialed by ABRET as R. EPT95930Visual ep test cns w/i&rNeurologistCredentialed by ABRET as R. EPT95933Blink reflex testNeurologist Physical Medicine & RehabPT w/ ABPTS95937Neuromuscular junction testNeurologist PT w/ ABPTS95938Somatosensory testingNeurologist Physical Medicine & RehabPT w/ ABPTS95939C motor evoked upr&lwer limbsNeurologist Physical Medicine & RehabPT w/ ABPTS95954EEG monitoring/giving drugsNeurologistPhysician only service95957EEG digital analysisNeurologistCredentialed by ABRET as R. EEG T95958EEG monitoring/function testNeurologistPhysician only service
Article - Independent Diagnostic Testing Facilities- physician supervision and technician requirements (A54953)
95957EEG digital analysisNeurologistCredentialed by ABRET as R. EEG T95958EEG monitoring/function testNeurologistPhysician only service95976Alys smpl cn npgt prgrmgNeurologistPhysician only service95977Alys cplx cn npgt prgrmgNeurologistPhysician only service95983Alys brn npgt prgrmg 15 minNeurologistPhysician only service95984Alys brn npgt prgrmg addl 15NeurologistPhysician only service96000Motion analysis, video/3DNeurologistPT w/ ABPTS96001Motion test w/ft press measNeurologistPT w/ ABPTS96002Dynamic surface EMGNeurologistPhysician Only Service96003Dynamic fine wire EMGNeurologistPhysician Only Service96004Phys review & interpretation of motion testsNeurologistPhysician only serviceG0248Demonstrate use home inr monPhysician: General SupervisionRegistered NurseG0249Provide inr test mater/equipPhysician: General SupervisionDemonstrates ProficiencyG0398Home sleep test/type 2 portaMD/DO certified with (ABSM), or has a Sleep Certification issued by (ABIM), (ABFM), (ABP), (ABPN), (ABOto), (AOBNP), (AOBFP), (AOBIM), (AOBOO)Registered Sleep Technologist (RST); Registered Polysomnographic Technologist (RPSGT); Certified Pulmonary Function Technologist (CPFT), Registered Pulmonary Function Technologist (RPFT), Certified Respiratory Therapist (CRT), Registered Respiratory Therapist (RRT)
Article - Independent Diagnostic Testing Facilities- physician supervision and technician requirements (A54953)
G0399Home sleep test/type 3 portaMD/DO certified with (ABSM), or Sleep Certification issued by (ABIM), (ABFM), (ABP), (ABPN), (ABOto), (AOBNP), (AOBFP), (AOBIM), (AOBOO)Registered Sleep Technologist (RST); Registered Polysomnographic Technologist (RPSGT); Certified Pulmonary Function Technologist (CPFT), Registered Pulmonary Function Technologist (RPFT), Certified Respiratory Therapist (CRT), Registered Respiratory Therapist (RRT)G0400Home sleep test/type 4 portaMD/DO certified with (ABSM), or has a Sleep Certification issued by (ABIM), (ABFM), (ABP), (ABPN), (ABOto), (AOBNP), (AOBFP), (AOBIM), (AOBOO)Registered Sleep Technologist (RST); Registered Polysomnographic Technologist (RPSGT); Certified Pulmonary Function Technologist (CPFT), Registered Pulmonary Function Technologist (RPFT), Certified Respiratory Therapist (CRT), Registered Respiratory Therapist (RRT)G2066Inter devc remote 30dBoard Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or Credentialed by CCI: CCT; Certified Rhythm Analysis Technician (CRAT), NCCT-NCET, NHA-CET0501TCor FFR Derived Cor CTA DataBoard Certified CardiologistN/A0502TCor FFR Data Prep & TransmisBoard Certified CardiologistN/A0503TCor FFR Alys Gnrj FFR MdlBoard Certified CardiologistN/A0504TCor FFR Data Review I&RBoard Certified CardiologistN/AKey for Abbreviations used in the table:The physician (MD/DO) performing the service must meet the criteria in our Polysomnography and OtherSleep Studies LCD (L36839)Physician and Technician Requirements for Sleep Studies and Polysomnography Testing:The physician performing the service must meet one of the following:
Article - Independent Diagnostic Testing Facilities- physician supervision and technician requirements (A54953)
Physician and Technician Requirements for Sleep Studies and Polysomnography Testing:The physician performing the service must meet one of the following:be a diplomate of the American Board of Sleep Medicine (ABSM);ORhas a Sleep Certification issued byONEof the following Boards:American Board of Internal Medicine (ABIM),American Board of Family Medicine (ABFM),American Board of Pediatrics (ABP),American Board of Psychiatry and Neurology (ABPN),American Board of Otolaryngology (ABOto),American Osteopathic Board of Neurology and Psychiatry (AOBNP),American Osteopathic Board of Family Medicine, (AOBFP)American Osteopathic Board of Internal Medicine, (AOBIM)American Osteopathic Board of Ophthalmology and Otorhinolaryngology (AOBOO);ORbe an active physician staff member of a credentialed sleep center or laboratory that have active physician staff members meeting the criteria above inaorb.Technician CredentialsThe technician performing the service must meet one of the following:American Board of Sleep Medicine (ABSM),Registered Sleep Technologist (RST);Board of Registered Polysomnographic Technologists (BRPT),Registered Polysomnographic Technologist (RPSGT);National Board for Respiratory Care (NBRC)Certified Pulmonary Function Technologist (CPFT)Registered Pulmonary Function Technologist (RPFT)Certified Respiratory Therapist (CRT)Registered Respiratory Therapist (RRT)Sleep Center or Laboratory Credentials (this is any site or place of service other than patients home where sleep studies or recordings are performed)The sleep facility credentials must be from the American Academy of Sleep Medicine (AASM), inpatient or outpatient;ORThe Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) sleep specific credentials for Ambulatory care sleep centers;ORAccreditation Commission for Health Care (ACHC)American Board of Registration of electroencephalographic and evoked potential technologists (ABRET)http://abret.org/Registered Electroencephalographic technologist (R.EEG T)Registered evoked potential technologist (R.EPT)American Board of Sleep Medicine (ABSM)http://absm.org/Registered Sleep Technologist (RST)
Article - Independent Diagnostic Testing Facilities- physician supervision and technician requirements (A54953)
American Board of Sleep Medicine (ABSM)http://absm.org/Registered Sleep Technologist (RST)American Registry of Diagnostic Medical Sonographers (ARDMS)https://www.ardms.org/Registered Diagnostic Medical Sonographer (RDMS)Registered Diagnostic Cardiac Sonographer (RDCS)Registered Vascular Technologist (RVT)American Registry of Magnetic Resonance Imaging Technologist (ARMRIT)http://www.armrit.org/Registered Magnetic Resonance Imaging Technologist -RT-MRAmerican Registry of Radiologic Technologists (ARRT)https://www.arrt.org/Certified Radiologic Technologist -Bone Densitometry (CRT-BD)Certified Radiologic Technologist Sonography (CRT-S)Certified Radiologic Technologist Vascular Sonography (CRT-VS)Certified Radiologic Technologist-Radiographer (CRT-R)Certified Radiologic Technologist -Computed Tomography (CRT-CT)Certified Radiologic Technologist -Magnetic Resonance Imaging (CRT-MR)Certified Radiologic Technologist- Radiation Therapy (CRT-T);Certified Radiologic Technologist-Nuclear Medicine (CRT-N).Board of Registered Polysomnographic Technologists (BRPT)http://www.brpt.org/Registered Polysomnographic Technologist (RPSGT)Cardiovascular Credentialing International (CCI)http://www.cci-online.org/Certified Cardiographic Technician (CCT)Certified Cardiac Sonographer (RCS)Registered Vascular Specialist (RVS)International Society for Clinical Densitometry (ISCD)http://www.iscd.org/Certified Densitometry Technologist (CDT)Certified Bone Densitometry Technologist (CBDT)National Board for Respiratory Care (NBRC)http://www.nbrc.org/Certified Pulmonary Function Technologist (CPFT)Registered Pulmonary Function Technologist (RPFT)Certified Respiratory Therapist (CRT)Registered Respiratory Therapist (RRT)
Article - Independent Diagnostic Testing Facilities- physician supervision and technician requirements (A54953)
Joint Commission on Allied Health personnel in Ophthalmology (JCAHPO)http://www.jcahpo.org/Joint Commission on Allied Health personnel in Ophthalmology (JCAHPO) offers three levels of certification:Certified Ophthalmic Assistant (COA)Certified Ophthalmic Technician (COT) (Intermediate Level)Certified Ophthalmic Medical Technologist (COMT) (Advanced Level)Nuclear Medicine Technologist Certification Boardhttp://www.nmtcb.org/Certified Nuclear Medicine Technologist (CNMT)Nuclear cardiology specialty examPet ExamsNational Center for Competency Testing (NCCT)National Certified ECG Technician (NCET)http://www.ncctinc.com/National Healthcareer Association (NHA)Certified EKG Technician (CET)https://www.nhanow.com/
(Medicare Claims Processing Manual)
Medicare Claims Processing Manual  Chapter 35  Independent Diagnostic Testing  Facility (IDTF)   Table of Contents  (Rev. 4473, 12- 06-19)  Transmittals for Chapter 35   10 - General Coverage and Payment Policies  10.1 -  The Term Independent Diagnostic Testing Facility (IDTF)  10.2 -  Claims Processing       10.2.1  Global billing       10.2.2  Separate T echnical and Professional Component Billing  20 - Ordering of Test  30 - Diagnostic Tests Subject to the Anti -Markup Payment Limitation  30.1 -  National Provider Identification (NPI) Reported on Claims  40 - Interpretations Performed Off the Premises of the IDTF  50 - Therapeutic Procedures   10 - General Coverage and Payment Policies  (Rev. 1506; Issued:  05- 16-08; Effective/Implementation Date:  06 -16-08)  Effective for diagnostic procedures performed on or after March 15, 1999, A/B MACs (B) will pay for diagnostic procedures unde r the physician fee schedule only when performed by a physician, a group practice of physicians, an approved supplier of portable x -ray services, a nurse practitioner, or a clinical nurse specialist when he or she performs a test he or she is authorized by  the State to perform, or an independent diagnostic testing facility (IDTF).  An IDTF may be a fixed location or a mobile entity. It is independent of a physician's office or hospital.   Refer to the Medicare Program Integrity Manual, Pub. 100- 08, chapter 10, for information concerning provider enrollment and instructions regarding entities that must enroll as and bill for diagnostic procedures as an independent diagnostic testing facility (IDTF).   10.1 - The Term Independent Diagnostic Testing Facility (ID TF)  (Rev. 1506; Issued:  05- 16-08; Effective/Implementation Date:  06 -16-08)  Consistent with 42 CFR 410. 33(a)(1), an IDTF is one that is independent both of an attending or consulting physicians office and of a hospital.  However, IDTF general coverage  and payment policy rules apply when an IDTF furnishes diagnostic procedures in a physicians office.   10.2 - Claims Processing  (Rev. 4473, Issued: 12- 6-19; Effective: 3 -9-20; Implementation: 3- 9-20)  A.  Billing Issues
(Medicare Claims Processing Manual)
10.2 - Claims Processing  (Rev. 4473, Issued: 12- 6-19; Effective: 3 -9-20; Implementation: 3- 9-20)  A.  Billing Issues   Nothing in this document or in the Medicare Enrollment Application, (CMS -855B) or the Internet -based Provider Enrollment, Chain and Ownership System shall be construed or interpreted to authorize billing by an IDTF, physician, physician group practice, or any other entity that would otherwise violate the physician self -referral prohibition set forth in 1877 of the Social Security Act and related regulations.  A/B MACs (Part B)  must deny claims submitted in violation of 1877 and demand refunds of any payme nts that have been made in violation of 1877.  Consistent with 42 CFR 410.32(a), the supervisory physician for the IDTF, whether or not for a mobile unit, may not order tests to be performed by the IDTF, unless the supervisory physician is the patients t reating physician and is not otherwise prohibited from referring to the IDTF.  The supervisory physician is the patients treating physician if he or she furnishes a consultation or treats the patient for a specific medical problem and uses the test result s in the management of the patients medical problem.   If an IDTF wants to bill for an interpretation performed by a physician who does not share a practice with the IDTF, the IDTF must meet certain conditions concerning the anti-markup payment limitation.   If a physician working for an IDTF (or a party related to the IDTF through common ownership or control as described in 42 CFR 413.17) does not order the technical component or professional component  of a diagnostic test (excluding clinical diagnostic la boratory tests), it would not be subject to the anti -markup payment limitation.  (See Pub. 100- 04, chapter 1, 30.2.9)   B.  Transtelephonic and Electronic Monitoring Services
(Medicare Claims Processing Manual)
B.  Transtelephonic and Electronic Monitoring Services   Transtelephonic and electronic monitoring services (e.g., 24 hour ambulatory EKG monitoring, pacemaker monitoring and cardiac event detection) may perform some of their services without actually seeing the patient.  Most but not all of these billing codes are 93012 ,93014, 93040, 93224, 93225, 93226, 93232, 93230, 93231, 93233, 93236, 93270, 93271, 93731, 93733, 93736, 95953, 95956,  These monitoring service entities should be classified as IDTFs and must meet all IDTF requirements.  We currently do not have specific certification standards for their technicians; technician credentialing requirements for them are at A/B MAC  (Part B) discretion.  They do require a supervisory physician who performs General Supervision.  Final enrollment of a transtelephonic or electronic monitoring service as an IDTF requires a site visit.   For any entity t hat lists and will bill codes 93012, 93014, 93268, 93270, 93271, 93272, the A/B MAC (Part B) must make a written determination that the entity actually has a person available on a 24 hour basis to answer telephone inquiries.  Use of an answering service in  lieu of the actual person is not acceptable.  The person performing the attended monitoring should be listed in Section 3 of Attachment 2 of Form CMS -855B.  The qualifications of the person are at the A/B MAC (Part B) s discretion.  The A/B MAC (Part B) s hall check that the person is available by attempting to contact the applicant during non- standard business hours.  In Particular, at least one of the contact calls should be made between midnight and 6:00 AM.  If the applicant does not meet the availabili ty standard they should receive a denial.   C.  Slide Preparation Facilities and Radiation Therapy Centers
(Medicare Claims Processing Manual)
C.  Slide Preparation Facilities and Radiation Therapy Centers   Slide Preparation Facilities and Radiation Therapy Centers are not IDTFs.  Slide preparation facilities are entities that provide slide preparation serv ices and other kinds of services that are payable through the technical component of the surgical pathology service.  These entities do not provide the professional component of surgical pathology services or other kinds of laboratory tests.  The services that they provide are recognized by A/B MACs (Part B) for payment, as codes in the surgical pathology code range (88300) to (88399) with a technical component value under the physician fee schedule.  The services provided by these entities are usually orde red by and reviewed by a dermatologist.  Slide preparation facilities generally only have one or two people performing this service.   All enrolled Slide Preparation Facilities must enroll separately with their Medicare contractor.  Radiation therapy center s provide therapeutic services and therefore are not IDTFs.  Radiation therapy centers must enroll separately with their Medicare contractor.  10.2.1  Global Billing (Rev.  4473, Issued: 12- 6-19; Effective: 3 -9-20; Implementation: 3- 9-20)  Global billing is acceptable when both the TC and 26 modifier are performed by the same entity and both the TC and the 26 modifier are furnished within the same Medicare Physician Fee Schedule (MPFS) payment locality.  The TC and 26 may be furnished in different locations as long as they are furnished within the same MPFS payment locality.   If the global diagnostic test code is billed, report the name, address and NPI of the location where the technical component was furnished in Items 32 and 32a (or the 837P electronic claim equivalent).  See Pub. 100- 04, chapter 1, 80.3.2.1.2 and 80.3.2.1.3 for more information regarding what is required in Items 32 and 32a.   10.2.2 Separate Technical and Professional Component Billing  (Rev.  4473, Issued: 12- 6-19; Effective: 3 -9-20; Implementation: 3- 9-20)
(Medicare Claims Processing Manual)
10.2.2 Separate Technical and Professional Component Billing  (Rev.  4473, Issued: 12- 6-19; Effective: 3 -9-20; Implementation: 3- 9-20)  When the TC and 26 modifier are billed separately (not billed globally), report the name, address and NPI of the location where each component was performed.  If the billing provider has an enrolled practice location at the address where the service was performed, the billing provider/supplier may report their own name, address and NPI in Items 32 and 32a (or the 837P electronic claim equivalent).   If the professional component service was performed at an unusual or infrequently used location, the location of the providers/suppliers closest Medicare -enrolled practice location may be used in Item 32.  The NPI in Item 32a must correspond to the entity identified in Item 32 (no matter if it is the group, hospital, t he IDTF, or the individual physician).  The only exception for Medicare claims is when a service is performed out of jurisdiction and is subject to the anti-markup or a reference lab service. See Pub. 100- 04, chapter 1,  30.2.9 and chapter 16, 40.1 for i nstructions specific to anti -markup and reference lab, respectively.   See, Pub. 100- 04, chapter 1, 80.3.2.1.2 and 80.3.2.1.3 for more information regarding what is required in Items 32 and 32a.  20 - Ordering of Test  (Rev. 1506; Issued:  05- 16-08; Effecti ve/Implementation Date:  06 -16-08)  All procedures performed by the IDTF must be specifically ordered in writing by the physician or practitioner who is treating the beneficiary, that is, the physician who is furnishing a consultation or treating a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem.  (Nonphysician practitioners may order tests as set forth in CFR 410.32(a)(3).)
(Medicare Claims Processing Manual)
The order must specify the diagnosis or ot her basis for the testing.  The supervising physician for the IDTF may not order tests to be performed by the IDTF, unless the IDTF's supervising physician is in fact the beneficiary's treating physician.  That is, the physician in question had a relations hip with the beneficiary prior to the performance of the testing and is treating the beneficiary for a specific medical problem.  The IDTF may not add any procedures based on internal protocols without a written order from the treating physician.   30 - Diagnostic Tests Subject to the Anti -Markup Payment Limitation  (Rev. 4473, Issued: 12- 6-19; Effective: 3 -9-20; Implementation: 3- 9-20)  In most instances, physicians working for an IDTF do not order diagnostic tests because such tests are generally ordered by  the patients treating physician.  If a physician working for an IDTF does not order a diagnostic test, the test is not subject to the anti -markup payment limitation.  However, if a physician working for an IDTF (or a physician financially related to the IDTF through common ownership or control) orders a diagnostic test payable under the Medicare Physician Fee Schedule (MPFS), the anti -markup payment limitation may apply (depending on whether the performing physician or other supplier meets the sharing a practice requirements).  For additional information, see Pub. 100- 04, chapter 1, 30.2.9.   If a physician working for an IDTF (or a physician financially related to the IDTF through common ownership or control) orders and the IDTF bills for a diagnostic test that is performed by another physician or supplier, the performing physician or other supplier must be enrolled in the Medicare program.  No formal reassignment is necessary; however, reassigned diagnostic testing services may also be subject to the a nti-markup payment limitation.   The billing entity must report using the ASC X12 837 professional claim format or on the Form CMS -1500 the name, NPI, and address of the performing physician or other supplier.  The acquisition price of the either the techni cal component or professional component  of the diagnostic test must also be reported on the claim.