evekhm/cms_iom_500 huggingface dataset:
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
9611604Board Certified* Psychiatrist, Clinical Psychologist or Qualified Independent PsychologistPhysician Service Code  must be performed by a physician or other qualified health care professional9612104Board Certified* Psychiatrist, Clinical Psychologist or Qualified Independent PsychologistPhysician Service Code  must be performed by a physician or other qualified health care professional9613004Board Certified* Psychiatrist, Clinical Psychologist or Qualified Independent PsychologistPhysician Service Code  must be performed by a physician or other qualified health care professional9613104Board Certified* Psychiatrist, Clinical Psychologist or Qualified Independent PsychologistPhysician Service Code  must be performed by a physician or other qualified health care professional9613204Board Certified* Psychiatrist, Clinical Psychologist or Qualified Independent PsychologistPhysician Service Code  must be performed by a physician or other qualified health care professional9613304Board Certified* Psychiatrist, Clinical Psychologist or Qualified Independent PsychologistPhysician Service Code  must be performed by a physician or other qualified health care professional9613604Board Certified* Psychiatrist, Clinical Psychologist or Qualified Independent PsychologistPhysician Service Code  must be performed by a physician or other qualified health care professional9613704Board Certified* Psychiatrist, Clinical Psychologist or Qualified Independent PsychologistPhysician Service Code  must be performed by a physician or other qualified health care professional9613804Board Certified* Psychiatrist, Clinical Psychologist or Qualified Independent PsychologistPhysician Service Code  must be performed by a physician or other qualified health care professional9613904Board Certified* Psychiatrist, Clinical Psychologist or Qualified Independent PsychologistPhysician Service Code  must be performed by a physician or other qualified health care professional9614604Board Certified* Psychiatrist, Clinical Psychologist or Qualified Independent PsychologistPhysician Service Code  must be performed by a physician or other qualified health care professional0509T01Board Certified* Ophthalmologist, Neurologist or OptometristCredentialed by JCAHPO: COT or COMT0554T09Board Certified* Radiologist or UrologistState License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT0555T09Board Certified* Radiologist or UrologistState License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT0556T09Board Certified* Radiologist or Urologist
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT0556T09Board Certified* Radiologist or UrologistState License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT0557T09Board Certified* Radiologist or UrologistState License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT0558T09Board Certified* Radiologist or UrologistState License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT0604T09Board Certified* Ophthalmologist or OptometristN/A0605T09Board Certified* Ophthalmologist or OptometristN/A0606T09Board Certified* Ophthalmologist or OptometristN/A0607T09Board Certified* CardiologistState Licensed RN or Paramedic or Credentialed by NHA: CET or CCI: CCT or CRAT0608T09Board Certified* CardiologistState Licensed RN or Paramedic or Credentialed by NHA: CET or CCI: CCT or CRAT0609T09Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty CertificationCredentialed by ARRT: MR or ARMRIT: MRI0610T09Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty CertificationCredentialed by ARRT: MR or ARMRIT: MRI0611T09Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty CertificationCredentialed by ARRT: MR or ARMRIT: MRI0612T09Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty CertificationCredentialed by ARRT: MR or ARMRIT: MRI0615T09Board Certified* NeurologistN/A0648T09
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
Credentialed by ARRT: MR or ARMRIT: MRI0615T09Board Certified* NeurologistN/A0648T09Board Certified* Radiologist, Gastroenterologist or HepatologistCredentialed by ARRT: MR or ARMRIT: MRI0649T09Board Certified* Radiologist, Gastroenterologist or HepatologistCredentialed by ARRT: MR or ARMRIT: MRI0683T02Board Certified* CardiologistState Licensed: RN or Paramedic or Credentialed by CCI: CCT or NHA: CET0685T02Board Certified* CardiologistState Licensed: RN or Paramedic or Credentialed by CCI: CCT or NHA: CET0689T01Board Certified* RadiologistCredentialed by ARDMS: RDMS or ARRT: R.T.-S0690T01Board Certified* RadiologistCredentialed by ARDMS: RDMS or ARRT: R.T.-S0694T01Board Certified* RadiologistState License: General Radiographer or Credentialed by ARRT: R.T.-R0696T09Board Certified* CardiologistState Licensed: RN or Paramedic or Credentialed by CCI: CCT or NHA: CET0697T02Board Certified* Radiologist, Gastroenterologist or HepatologistCredentialed by ARRT: MR or ARMRIT: MRI0698T02Board Certified* Radiologist, Gastroenterologist or HepatologistCredentialed by ARRT: MR or ARMRIT: MRI0723T09Board Certified* Radiologist, Gastroenterologist or HepatologistCredentialed by ARRT: MR or ARMRIT: MRI0724T09Board Certified* Radiologist, Gastroenterologist or HepatologistCredentialed by ARRT: MR or ARMRIT: MRI0742T01Board Certified* Nuclear Medicine, Cardiology or RadiologyCredentialed by ARRT: N or NMTCB: CNMT0764T09Board Certified* Internist or CardiologistRN, LPN/LVN or State Licensed Paramedic or Credentialed by CCI: CCT or NHA: CET
Article - Billing and Coding: Independent Diagnostic Testing Facility (IDTF) (A53252)
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) (A53252)
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) (A53252)
*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 athttps://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 A56773, Billing and Coding: Neurophysiology Evoked Potentials for additional information on CPT codes 92651-92653, 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) (A53252)
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-medicineABIM: 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.orAmerican 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) (A53252)
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 (ARDMShttp://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.org/Certified Magnetic Resonance Imaging TechnologistAmerican Society of Neuroimaging (ASN)http://www.asnweb.org/ASN: Neuroimaging Subspecialty CertificationThe American Registry of Radiologic Technologists (ARRT)https://www.medical-professionals.com/en/arrt-certification-guideCertified Magnetic Resonance Imaging Technologist (ARRT: MR) Certified and Registered Technologist -Bone Densitometry (R.T-BD) Certified and Registered Technologist-Breast Sonography (R.T.-BSCertified 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) (A53252)
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)http://www.jcahpo.org/newsite/certificationhome.htmJCAHPO 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 Disorder 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: Therapy Driving Evaluations (A53289)
CMS National Coverage PolicyN/AArticle TextMedicare does not reimburse evaluations performed solely to assess a beneficiary's ability to drive a vehicle. In order for a service to be covered, the service must have a benefit category in the statute Title 18 of the Social Security Act (SSA), it must not be excluded, and it must be reasonable and necessary. There is no benefit category for driving evaluations.In addition, both screening (except as specifically exempted by statute) and routine physical examinations are excluded from coverage. 42 United States Code (USC) 1395y (a) describes routine physical checkups as:1. Examinations performed for a purpose other than treatment or diagnosis of a specific illness, symptom, complaint, or injury.2. Examinations required by insurance companies, business establishments, government agencies or other third parties.For Medicare purposes, when services provided are related solely to driving, they are not reasonable or necessary for the diagnosis or treatment of an illness or injury and are excluded from coverage under the program by SSA 1862(a)(1).This is a statutory exclusion. The beneficiary is liable for the charges and no Advance Beneficiary Notice of Noncoverage (ABN) is required. However, providers are encouraged to provide a voluntary ABN. Append modifier GX (Notice of Liability Issue, Voluntary under Payer Policy) to any billed line item.Sources: CMS Internet Only Manual (IOM), Medicare Claims Processing Manual, Publication 100-04, Chapter 1 Section 60 Social Security Act (SSA) Sections 1861 and 1862(a)(1) 42CFR 411.15(a)
Article - Billing and Coding: Therapy Driving Evaluations (A53292)
CMS National Coverage PolicyN/AArticle TextMedicare does not reimburse evaluations performed solely to assess a beneficiary's ability to drive a vehicle. In order for a service to be covered, the service must have a benefit category in the statute Title 18 of the Social Security Act (SSA), it must not be excluded, and it must be reasonable and necessary. There is no benefit category for driving evaluations.In addition, both screening (except as specifically exempted by statute) and routine physical examinations are excluded from coverage. 42 United States Code (USC) 1395y (a) describes routine physical checkups as:1. Examinations performed for a purpose other than treatment or diagnosis of a specific illness, symptom, complaint, or injury.2. Examinations required by insurance companies, business establishments, government agencies or other third parties.For Medicare purposes, when services provided are related solely to driving, they are not reasonable or necessary for the diagnosis or treatment of an illness or injury and are excluded from coverage under the program by SSA 1862(a)(1).This is a statutory exclusion. The beneficiary is liable for the charges and no Advance Beneficiary Notice of Noncoverage (ABN) is required. However, providers are encouraged to provide a voluntary ABN. Append modifier GX (Notice of Liability Issue, Voluntary under Payer Policy) to any billed line item.Sources: CMS Internet Only Manual (IOM), Medicare Claims Processing Manual, Publication 100-04, Chapter 1 Section 60 Social Security Act (SSA) Sections 1861 and 1862(a)(1) 42CFR 411.15(a)
Article - Billing and Coding: Wound Care & Debridement – Provided by a Therapist, Physician, NPP or as Incident-to Services (A53296)
CMS National Coverage PolicyN/AArticle TextThis article clarifies wound care and debridement services provided by a therapist, physician, non-physician practitioner (NPP) or as incident-to services.Medical NecessityAll Providers (including therapists) must document the medical necessity for all services provided. If there is no documented evidence (e.g., objective measurements) of ongoing significant benefit, then the medical record documentation must provide other clear evidence of medical necessity for treatments. The medical record must also clearly indicate the complexity of skills required by the treating practitioner/clinician.CodingProper wound care coding requires careful reading of all Current Procedural Terminology (CPT) code descriptors and related CPT Manual instructions. Providers should note that some codes are per session or per wound surface area, not per wound or site.Evaluation and Management (E/M) Coding RequirementsOnlyphysicians and NPPs (Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs) can provide and bill E/M and CPT 11000 series codes when the services are appropriate and state licensure allows. These services may not be provided as incident-to services by hospital staff. Services provided by qualified incident-to hospital staff, must meet both the incident-to service delivery requirements and the CPT descriptor requirements for the specific procedure.*Note: For claims with dates of service prior to January 1, 2014: Hospitals maybillany E/M level within the"established patient"category that corresponds to the resources used in the provision of the covered 99211 service in the specific clinic. The charge must be the same for all patients. See the CMS manuals for additional billing instructions. Reference the Noridian article titled"Incident To" Clarification for OPPS and CAH Outpatientattached below for additional information.For claims with dates of service on or after January 1, 2014: Hospitals may only bill HCPCS G0463. The charge must be the same for all patients. See the CMS manuals for additional billing instructions. Reference the Noridian article titled"Incident to" Clarification for OPPS and CAH Outpatientattached below for additional information.Physical Medicine and Rehabilitation (PM&R) Codes (i.e. 97597, 97598, 97602)
Article - Billing and Coding: Wound Care & Debridement – Provided by a Therapist, Physician, NPP or as Incident-to Services (A53296)
Physical Medicine and Rehabilitation (PM&R) Codes (i.e. 97597, 97598, 97602) A physician, NPP or therapist acting within their scope of practice and licensure may provide debridement services and use the PM&R codes including CPT 97597, 97598 and 97602. These codes must only be billed for services that include medically necessary skilled debridement services. Hospital staff acting within their scope of practice and/or licensure may provide wound care, including debridement services, incident-to the services of a physician/NPP. Staff providing therapy services incident-to the physician treatment plan must meet the qualification guidelines established for auxiliary personnel as described in the IOMMedicare Benefit Policy Manual, Publication 100-02, Chapter 15, Sections 220(A), 230.5.CPT 97597, 97598, 97602 are considered sometimes therapy codes according to the IOMMedicare Claims Processing Manual, Publication 100-04, Chapter 5, Section 20. As such, these treatment codes may be provided without a therapy plan of care by physician/NPPs or as incident-to services. When these sometimes therapy services are provided under a physician's/NPPs treatment plan they should be billed without a therapy modifier. When wound care services are delivered by therapists, there must be a physician certified therapy plan of care based on a thorough evaluation signed by the treating physician or NPP. The services must be billed using the appropriate therapy modifier and deliver within the CMS therapy guidelines found in the IOMMedicare Benefit Policy Manual, Publication 100-02, Chapter 15, Sections 100 and 220-230.Dressing ChangeA dressing change may not be billed as either a debridement or other wound care service under any circumstance (e.g., CPT 97597, 97598, 97602).