Independent Diagnostic Testing Facilities- physician supervision and technician requirements

This article is a list of diagnostic services that may be performed in an Independent Diagnostic Testing Facilities (IDTF) provided they have the appropriate physician supervision and technician requirements. The CPT codes in this document do not imply coverage of the procedure. All of the procedure codes are subject to Medicare rules and regulations, applicable Local Coverage Decisions (LCD’s), and medical necessity.

National credentialing bodies must be a member of the National Organization for Competency Assurance (NOCA) or certified by the Commission for Certifying Agencies (NCCA) which is the accreditation body of NOCA. In the absence of a National Credentialing Body, the Contractor has the discretion to approve educational requirements or other certifications. For example, we are allowing technicians who are certified by Cardiovascular Credentialing International (CCI) for cardiac monitoring services since there is no agency for those services that is recognized by NOCA or NCCA.

Supervising physicians must be board eligible or board certified. An IDTF wishing to add a supervising physician to their file that is not of the specialty listed in the appendix may send in additional information outlining their qualifications such as additional training or education to the enrollment department. The information will be reviewed by the medical staff.

Section 135(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) amended section 1834(e) of the Social Security Act and required the Secretary to designate organizations to accredit suppliers, including but not limited to physicians, non-physician practitioners and Independent Diagnostic Testing Facilities, that furnish the technical component (TC) of advanced diagnostic imaging services.

MIPPA specifically defines advanced diagnostic imaging procedures as including diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET). In order to furnish the TC of advanced diagnostic imaging services for Medicare beneficiaries the suppliers must be accredited.

The Centers for Medicare & Medicaid Services (CMS) approved four national accreditation organizations to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures:

1. American College of Radiology (ACR) 
2. Intersocietal Accreditation Commission (IAC) 
3. RadSite
4. The Joint Commission (TJC)

All accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff. To obtain additional information about the accreditation process, please contact the accreditation organizations shown above.

Supplies
Certain items (e.g., radiopharmaceutical agents, special contrast agents, medications, etc.) or services that are necessary for the performance of specific diagnostic tests may also 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. The items or services may not be listed on the table. 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.

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. Each IDTF will have a specific and unique list of HCPCS codes for which it can be paid. It is the responsibility of the IDTF to obtain Contractor approval to bill each HCPCS code that it intends to bill.

Unlisted procedure codes are not included in the table below. Providers will need to send in a written request explaining the procedure they are performing. If the Contractor Medical Director (CMD) determines it to be an appropriate diagnostic procedure that can be safely performed in an IDTF, it will be added to the provider’s file.

A procedure code that includes a diagnostic and/or therapeutic procedure may be allowed in an IDTF provided the service performed is diagnostic.

The level of supervision listed on the database must be provided by one of the physicians listed as a supervising physician in the table below. The numeric diagnostic supervision levels assigned to each CPT or HCPCS code are found on the Medicare Physician Fee Schedule Database (MPFSDB).

These are abbreviated code descriptions of the procedures that may be allowed in an IDTF. Providers should consult a CPT book for the complete code description of the procedures they are performing/billing.

Key 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:

1. The physician performing the service must meet one of the following:
   
   
   1. be a diplomate of the American Board of Sleep Medicine (ABSM);
      OR
   2. has a Sleep Certification issued by ONE of 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);
      OR
   3. be an active physician staff member of a credentialed sleep center or laboratory that have active physician staff members meeting the criteria above in a or b.
2. Technician Credentials
   The 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 patient’s 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;
  OR
• The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) sleep specific credentials for Ambulatory care sleep centers;
  OR
• Accreditation 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)

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-MR

American 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)

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 Board
http://www.nmtcb.org/
Certified Nuclear Medicine Technologist (CNMT)
Nuclear cardiology specialty exam
Pet Exams

National 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/