evekhm/cms_iom_500 huggingface dataset:
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
0764T09Board Certified* Internist or CardiologistRN, LPN/LVN or State Licensed Paramedic or Credentialed by CCI: CCT or NHA: CET0765T09Board Certified* Internist or CardiologistRN, LPN/LVN or State Licensed Paramedic or Credentialed by CCI: CCT or NHA: CET0779T09Board Certified* GastroenterologistRN0804T09Board Certified* CardiologistRN, State Licensed Paramedic or Credentialed by CCI: CCT or NHA: CETG010603Board Certified* GastroenterologistState License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-N or NMTCB: CNMTG013001Board Certified* Radiologist or Orthopaedic SurgeonState License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-BDG023501Board Certified* Nuclear Medicine or RadiologyState License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-N or NMTCB: CNMTG024801Board Certified* CardiologistRNG024901Board Certified* CardiologistDemonstrates ProficiencyG027909Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-MG039809Physician Certified by ABSM or ABMS: Sleep Medicine OR ABFM, ABIM, ABOHNS, ABPN or AOA: Sleep Medicine Subspecialty CertificationCredentialed by BRPT: RPSGT or CPSGT, ABRET: R. EEG T. (Polysomnography) or NBRC: CRT, SDS or RRTG039909Physician Certified by ABSM or ABMS: Sleep Medicine OR ABFM, ABIM, ABOHNS, ABPN or AOA: Sleep Medicine Subspecialty Certification
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
G039909Physician Certified by ABSM or ABMS: Sleep Medicine OR ABFM, ABIM, ABOHNS, ABPN or AOA: Sleep Medicine Subspecialty CertificationCredentialed by BRPT: RPSGT or CPSGT, ABRET: R. EEG T. (Polysomnography) or NBRC: CRT, SDS or RRTG040009Physician Certified by ABSM or ABMS: Sleep Medicine OR ABFM, ABIM, ABOHNS, ABPN or AOA: Sleep Medicine Subspecialty CertificationCredentialed by BRPT: RPSGT or CPSGT, ABRET: R. EEG T. (Polysomnography) or NBRC: CRT, SDS or RRTQ003501Board Certified* CardiologistCredentialed by CCI: CCT, NHA: CET, State Licensed Paramedic or RN
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
*Note:The CPT/HCPCS codes that have Licensed Audiologist designated with an asterisk in the Technician Qualification Requirements column would not be subject to direct supervision of a physician. Licensed Audiologist designated with an asterisk are for CPT/HCPCS codes included on the CMS Audiology Code List (revised CY2023). As defined in the Social Security Act, section 1861(ll) (3), the term audiology services specifically means such hearing and balance assessment services furnished by a qualified audiologist as the audiologist is legally authorized to perform under State law (or the State regulatory mechanism provided by State law), as would otherwise be covered if furnished by a physician. Additional information on Audiology Services and the CMS Audiology Code List may be found on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-For-Service-Payment/PhysicianFeeSched/audiology.htmlNote:The technical component (TC) of services represented by CPT codes 95925-95927 and 95938-95939 may be performed by an appropriately certified PT. However, in an IDTF supervision by the appropriate physician(s) is required for global and professional component (PC) billing.Please refer to A57540, Billing and Coding: Somatosensory Testing for additional information on CPT codes 95925-95930, 95938 and 95939.Note:Board Certified* Nuclear Medicine meets the supervising physician and interpreting physician qualification requirements for the tests 93015, 93016, 93017, and 93018 when performed in conjunction with myocardial perfusion and cardiac blood pool imaging studies. In this situation, a Certified Nuclear Medicine Technologist (ARRT: N or NMTCB: CNMT) meets the technician qualification requirements for 93015, 93016, and 93017 when performed under direct supervision of a Board Certified* Nuclear Medicine physician.
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
Note:Nonphysician practitioners such as nurse practitioners (NPs), clinical nurse specialists (CNSs) and physician assistants (PAs) who personally perform diagnostic psychological and neuropsychological tests are excluded from having to perform these tests under the general supervision of a physician or a clinical psychologist (CP). Rather, NPs and CNSs must perform such tests under the requirements of their respective benefit instead of the requirements for diagnostic psychological and neuropsychological tests. Accordingly, NPs and CNSs must perform tests in collaboration (as defined under Medicare law at section 1861(aa)(6) of the Act) with a physician. PAs perform tests under the general supervision of a physician as required for services furnished under the PA benefit. (Reference CMS IOM Pub. 100-02, Chapter 15, Section 80.2)Key for IDTF Table AbbreviationsAmerican Association of Electrodiagnostic Technologists (AAET)http://www.aaet.infoRegistered Nerve Conduction Study Technologist (R.NCS.T.)American Board of Electrodiagnostic Medicine (ABEM)http://www.abemexam.org/Certified Nerve Conduction Technologist (CNCT)American Board of Family Medicine (ABFM)http://www.theabfm.orgABFM: Sleep Medicine Subspecialty CertificationAmerican Board of Internal Medicine (ABIM)https://www.abim.org/certification/policies/internal-medicine-subspecialty-policies/sleep-medicine/ABIM: Sleep Medicine Subspecialty CertificationAmerican Board of Nuclear Medicine (ABNM)http://www.abnm.orgAmerican Board of Otolaryngology - Head and Neck Surgery (ABOHNS)https://www.abohns.org/ABOHNS: Sleep Medicine Subspecialty CertificationAmerican Board of Psychiatry and Neurology (ABPN)http://www.abpn.comABPN: Sleep Medicine Subspecialty CertificationAmerican Board of Medical Specialties (ABMS)http://www.abms.orgAmerican Board of Physical Therapy Specialties (ABPTS)https://specialization.apta.orgABPTS Physical TherapistAmerican Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET)
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
American Board of Physical Therapy Specialties (ABPTS)https://specialization.apta.orgABPTS Physical TherapistAmerican Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET)http://www.abret.org/exam_info/eligibility.phpRegistered Electroencephalographic technologist (R. EEG T.)Registered Evoked Potential Technologist (R. EP T.)American Board of Sleep Medicine (ABSM)www.absm.orgAmerican Osteopathic Association (AOA)https://osteopathic.orgAOA Doctor of Osteopathic Medicine (D.O.)American Registry of Diagnostic Medical Sonographers (ARDMS)http://www.ardms.orgRegistered Diagnostic Cardiac Sonographer (RDCS)Registered Diagnostic Medical Sonographer (RDMS)Registered Vascular Technologist (RVT)American Registry of Magnetic Resonance Imaging Technologists (ARMRIT)http://www.armrit.orgCertified Magnetic Resonance Imaging TechnologistAmerican Society of Neuroimaging (ASN)http://www.asnweb.orgASN: Neuroimaging Subspecialty CertificationThe American Registry of Radiologic Technologists (ARRT)https://www.medical-professionals.com/en/arrt-certification-guide/Certified Magnetic Resonance Imaging Technologist (ARRT: MR) Certified and Registered Technologist -Bone Densitometry (R.T.-BD) Certified and Registered Technologist-Breast Sonography (R.T.-BS)Certified and Registered Technologist  Cardiac Interventional Radiography (ARRT: CI Certified and Registered Technologist -Computed Tomography [R.T.-CT])Certified and Registered Technologist -Magnetic Resonance Imaging (R.T.-MR) Certified and Registered Technologist-Mammography (R.T.-M)Certified and Registered Technologist-Nuclear Medicine Technology (R.T.-N)Certified and Registered Technologist-Radiography (R.T.-R)Certified and Registered Technologist Sonography (R.T.-S)Certified and Registered Technologist Vascular Sonography (R.T.-VS)The Board of Certification of the Ophthalmic Photographers Society
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A57807)
Certified and Registered Technologist Sonography (R.T.-S)Certified and Registered Technologist Vascular Sonography (R.T.-VS)The Board of Certification of the Ophthalmic Photographers Societyhttps://mail.opsweb.org/Certif/Certif.htmlCertified Retinal Angiographer (CRA)Board of Registered Polysomnographic Technologists (BRPT)http://www.brpt.org/Registered Polysomnographic Technologist (RPSGT)Certified Polysomnographic Technician (CPSGT)Cardiovascular Credentialing International (CCI)http://www.cci-online.org/Certified Cardiographic Technician (CCT)Registered Cardiac Sonographer (RCS)Registered Cardiovascular Invasive Specialist (RCIS)Registered Vascular Specialist (RVS)Certified Rhythm Analysis Technician (CRAT)The International Society for Clinical Densitometry (ISCD)http://www.iscd.org/Certified Bone Densitometry Technologist (CBDT)Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO)https://www.jcahpo.org/certification/certifications/JCAHPO offers three levels of certification: Certified Ophthalmic Assistant (COA)Certified Ophthalmic Technician (COT) (Intermediate Level)Certified Ophthalmic Medical Technologist (COMT) (Advanced Level)National Board for Respiratory Care (NBRC)http://www.nbrc.orgCertified Pulmonary Function Technologist (CPFT)Registered Pulmonary Function Technologist (RPFT)Certified Respiratory Therapist (CRT)Sleep Disorders Specialist (SDS)Registered Respiratory Therapist (RRT)National Healthcareer Association (NHA)https://www.nhanow.com/Certified EKG Technician (CET)Nuclear Medicine Technology Certification Board (NMTCB)http://www.nmtcb.org/Certified Nuclear Medicine Technologist (CNMT)United Council for Neurologic Subspecialties (UCNS)http://www.ucns.org/UCNS: Neuroimaging Subspecialty Certification
Article - Billing and Coding: Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults (A57813)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.Article TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) forRepetitive Transcranial Magnetic Stimulation (rTMS) in Adults L34869.Documentation RequirementsAll documentation must be maintained in the patients medical record and 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.The medical record documentation must support the medical necessity of the services as directed in this policy.
Article - Billing and Coding: Facet Joint Interventions for Pain Management (A57826)
CMS National Coverage PolicyN/AArticle Text
Article - Billing and Coding: Facet Joint Interventions for Pain Management (A57826)
Refer to the Local Coverage Determination (LCD) Facet Joint Interventions for Pain Management, for reasonable and necessary requirements and frequency limitations.The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits.General Guidelines for Claims submitted to Part A or Part B MAC:Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.Coding GuidanceProviders should refer to the applicable AMA CPT Manual to assist with proper reporting of these services.This policy applies only to cervical/thoracic or lumbar facet procedures and does not apply to other joint procedures (such as sacral injections, sacroiliitis, epidural or other spinal procedures).Diagnostic and Therapeutic Procedures:Each facet level in the spinal region is composed of bilateral facet joints (i.e., there are two facet joints per level, one on the right side and one on the left). Unilateral or bilateral facet interventions may be performed during the facet joint procedure (a diagnostic nerve block, a therapeutic facet joint (intraarticular) injection, a medial branch block injection, or the medial branch radiofrequency ablation (neurotomy) in one session. A bilateral intervention is still considered a single level intervention.Each unilateral or bilateral intervention at any level should be reported as one unit, with bilateral intervention signified by appending the modifier -50.Regions:
Article - Billing and Coding: Facet Joint Interventions for Pain Management (A57826)
Each unilateral or bilateral intervention at any level should be reported as one unit, with bilateral intervention signified by appending the modifier -50.Regions:An anatomic spinal region for paravertebral facet joint block (diagnostic or therapeutic), is defined as cervical\thoracic (CPT codes 64490, 64491, 64492) or lumbar\sacral (CPT codes 64493, 64494, 64495) per the AMA CPT Manual.Levels:64490 (cervical or thoracic) or 64493 (lumbar or sacral) reports a single level injection performed with image guidance (fluoroscopy or CT). Procedures performed under ultrasound guidance are not covered.64491 or 64494 describes a second level which should be reported separately in addition to the code for the primary procedure. 64491 should be reported in conjunction with 64490 and 64494 should be reported in conjunction with 64493.64492 or 64495 describes a third and additional levels and should be listed separately in addition to the code for the primary procedure and the second level procedure and cannot be reported more than once per day. 64492 should bereported in conjunction with 64490/64491 and 64495 should be reported in conjunction with 64493/64494.Laterality:Bilateral paravertebral facet injection procedures 64490 through 64495 should be reported with modifier -50.One to two levels, either unilateral or bilateral, are allowed per session per spine region (i.e., two (2) unilateral or two (2) bilateral levels per session).For services performed in the ASC, physicians must continue to use modifier 50. Only the ASC Facility itself must report the applicable procedure code on two separate lines, with one unit each and append the -RT and -LT modifiers to each line.KX modifier requirements:
Article - Billing and Coding: Facet Joint Interventions for Pain Management (A57826)
KX modifier requirements:The KX modifier should be appended to the line for all diagnostic injections. In most cases the KX modifier will only be used for the two initial diagnostic injections. If the initial diagnostic injections do not produce a positive response as defined by the policy and are not indicative of identification of the pain generator, and it is necessary to perform additional diagnostic injections, at a different level, append the KX modifier to the line.Aberrant use of the KX modifier may trigger focused medical review.Therapeutic injections:Documentation of why patient is not a candidate for RFA must be submitted for therapeutic treatment.Chemodenervation of nerve:Codes 64633, 64634, 64635, 64636 are reported per joint, not per nerve. Although two nerves innervate each facet joint, only one unit per code may be reported for each joint denervated, regardless of the number of nerves treated (AMA CPT Manual 2020).Each unilateral or bilateral intervention at any level should be reported as one unit, with bilateral intervention signified by appending the modifier -50.Region:An anatomic spinal region for thermal facet joint denervation is defined as cervical/thoracic (CPT codes 64633 and 64634) or lumbar/sacral (CPT codes 64635 and 64636) per the AMA CPT Manual.For neurolytic destruction of the nerves innervating the T12-L1 paravetebral facet joint, use 64633.Levels:64633 or 64635 describes a single level destruction by neurolytic agent performed with image guidance (fluoroscopy or CT)64634 or 64636 describes each additional level which should be reported separately in addition to the code for the primary procedure. 64634 should be used in conjunction with 64633 and 64636 should be used in conjunction with 64635.Laterality:For bilateral procedures report modifier -50 on each line in which the intervention was of a bilateral nature.For services performed in the ASC, physicians must continue to use modifier 50. Only the ASC Facility itself must report the applicable procedure code on two separate lines, with one unit each and append the -RT and -LT modifiers to each line.
Article - Billing and Coding: Facet Joint Interventions for Pain Management (A57826)
Non-thermal facet joint denervation (including chemical, low grade thermal energy (<80 degrees Celsius or any other form of pulsed radiofrequency) should not be reported with CPT codes 64633, 64634, 64635 or 64636. Theseservices should be reported with CPT code 64999. Code 64999 is non-covered when used to report non-thermal facet joint denervation.If facet joints are injected with biologicals or other substances not designated for this use the entire claim will deny perBenefit Policy ManualChapter 16: Section 180.Use of moderate or deep sedation, general anesthesia, and monitored anesthesia care (MAC) is usually unnecessary or rarely indicated for these procedures and not routinely reimbursable and therefore may be denied. In exceptional circumstances if the medical necessity of sedation is unequivocal and clearly documented in the medical record individual consideration may be considered on appeal.Documentation RequirementsThe patients medical record should include but is not limited to:
Article - Billing and Coding: Facet Joint Interventions for Pain Management (A57826)
The assessment of the patient by the performing provider as it relates to the complaint of the patient for that visit,Relevant medical historyResults of pertinent tests/proceduresSigned and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)
Article - Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors (A57831)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 80.1.2 A/B MAC (B) Contacts With Independent Clinical LaboratoriesCMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, 50.5 Jurisdiction of Laboratory Claims, 60.1.1 Independent Laboratory Specimen Drawing, 60.2. Travel Allowance.CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, 10 Reporting ICD Diagnosis and Procedure CodesArticle TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for MolDX:Next Generation Sequencing for Solid TumorsL38045.Relevant Article: Billing and Coding: MolDX: Testing of Multiple Genes A57503:To report a Next Generation Sequencing for Solid Tumors service, please submit the following claim information:Select the appropriate CPTcodeEnter 1 unit of service (UOS)Enter the appropriate DEX Z-Codeidentifier adjacent to the CPTcode in the comment/narrative field for the following Part B claim field/types:Loop 2400 or SV101-7 for the 5010A1 837PBox 19 for paper claimEnter the appropriate DEX Z-Codeidentifier adjacent to the CPTcode in the comment/narrative field for the following Part A claim field/types:Line SV202-7 for 837I electronic claimBlock 80 for the UB04 claim formSelect the appropriate ICD-10-CM codeNOTE:When entering the DEX Z-Codeon the SV101-7 documentation field for Part B claims please do not add additional characters and/or information on the line.
Article - Billing and Coding: MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies (A57837)
CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, 80.1.2 A/B MAC (B) Contacts With Independent Clinical LaboratoriesCMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, 50.5 Jurisdiction of Laboratory Claims, 60.1.1 Independent Laboratory Specimen Drawing, 60.2. Travel Allowance.CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, 10 Reporting ICD Diagnosis and Procedure CodesArticle TextThe information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: Next Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies L38047.Relevant Article: Billing and Coding: MolDX: Testing of Multiple Genes A57503:To report a Next Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies service, please submit the following claim information:Select the appropriate CPTcodeEnter 1 unit of service (UOS)Enter the appropriate DEX Z-Codeidentifier adjacent to the CPTcode in the comment/narrative field for the following Part B claim field/types:Loop 2400 or SV101-7 for the 5010A1 837PBox 19 for paper claimEnter the appropriate DEX Z-Codeidentifier adjacent to the CPTcode in the comment/narrative field for the following Part A claim field/types:Line SV202-7 for 837I electronic claimBlock 80 for the UB04 claim formSelect the appropriate ICD-10-CM codeNOTE:When entering the DEX Z-Codeon the SV101-7 documentation field for Part B claims please do not add additional characters and/or information on the line.