Archive
API

SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Independent Diagnostic Testing Facility (IDTF)

A57807

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
Superseded
To see the currently-in-effect version of this document, go to the section.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57807
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Independent Diagnostic Testing Facility (IDTF)
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
10/01/2023
Revision Ending Date
12/31/2023
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Internet-Only Manuals (IOMs)

  • CMS IOM Publication 100-04, Medicare Claims Processing Manual,
    • Chapter 1, Section 30.2 Assignment of Provider’s Right to Payment
    • Chapter 35, Independent Diagnostic Testing Facility (IDTF)
  • CMS IOM Publication 100-08, Medicare Program Integrity Manual,
    • Chapter 10, Section 10.2.2.4 Independent Diagnostic Testing Facilities (IDTFs)

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33910 Independent Diagnostic Testing Facility (IDTF). Please refer to the LCD for reasonable and necessary requirements.

IDTFs performing sleep studies per LCD L33405 (Polysomnography and Sleep Testing), must also be an accredited sleep center or laboratory.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

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 CPT/HCPCS codes for which it can be paid by the contractor, and it is the responsibility of the IDTF to obtain specific contractor approval to bill each CPT/HCPCS code that it intends to bill.

Physician Supervision of Diagnostic Procedures  

01 = 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).

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.*

*Note: The minimal level of physician supervision, which applies to ALL diagnostic tests, with the exceptions listed in the regulation, is “general supervision.”

The level of physician supervision required for diagnostic procedures can be found in the Medicare Physician Fee Schedule Database (MPFSDB). 


Credentialing Matrix

The 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.

CPT/ HCPCS CODES

LEVEL OF PHYSICIAN SUPERVISION

SUPERVISING PHYSICIAN QUALIFICATION REQUIREMENTS

TECHNICIAN QUALIFICATION REQUIREMENTS

0501T
0502T
0503T
0504T

9

Board Certified* Cardiologist

N/A

0508T

1

Board Certified* Radiologist or Podiatrist

ARDMS: RDMS or ARRT: R.T.-S or R.T.-BD

0509T

1

Board Certified* Ophthalmologist, Neurologist or Optometrist

Credentialed by JCAHPO: COT or COMT

0554T
0555T
0556T
0557T

9

Board Certified* Radiologist or Urologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

0558T

9

Board Certified* Radiologist or Urologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

0604T
0605T
0606T

 9

Board Certified* Ophthalmologist or Optometrist

N/A

0607T
0608T

 9

Board Certified* Cardiologist

State Licensed RN or Paramedic or Credentialed by NHA: CET or CCI: CCT or CRAT

0609T
0610T
0611T
0612T

 9

Board Certified* Radiologist OR ABPN: Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

0615T

 9

Board Certified* Neurologist

N/A

0648T

 9

Board Certified* Radiologist, Gastroenterologist or Hepatologist

Credentialed by ARRT: MR or ARMRIT: MRI

0649T

 9

Board Certified* Radiologist, Gastroenterologist or Hepatologist

Credentialed by ARRT: MR or ARMRIT: MRI

0683T

 2

Board Certified* Cardiologist

State Licensed: RN or Paramedic or Credentialed by CCI: CCT or NHA: CET

0685T

 2

Board Certified* Cardiologist

State Licensed: RN or Paramedic, or Credentialed by CCI: CCT or NHA: CET

0689T

 1

Board Certified* Radiologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

0690T

 1

Board Certified* Radiologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

0694T

 1

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

0696T

 9

Board Certified* Cardiologist

State Licensed: RN or Paramedic, or Credentialed by CCI: CCT or NHA: CET

0697T

 2

Board Certified* Radiologist, Gastroenterologist or Hepatologist

Credentialed by ARRT: MR or ARMRIT: MRI

0698T

 2

Board Certified* Radiologist, Gastroenterologist or Hepatologist

Credentialed by ARRT: MR or ARMRIT: MRI

0723T
0724T

 9

Board Certified* Radiologist, Gastroenterologist or Hepatologist

Credentialed by ARRT: MR or ARMRIT: MRI

0742T

 1

Board Certified* Nuclear Medicine or ABMS: Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

0764T
0765T

 9

Board Certified* Internist or Cardiologist

RN, Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN) or State licensed Paramedic or Credentialed by CCI: CCT or NHA: CET

0779T

 9

Board Certified* Gastroenterologist

RN

0804T

 9

Board Certified* Cardiologist

RN, State Licensed Paramedic or Credentialed by CCI: CCT or NHA: CET

10005
10006

 9

Board Certified* Radiologist

Credentialed by ARRT in ultrasound

10007
10008

 9

Board Certified* Radiologist

Credentialed by ARRT in fluoroscopy

10009
10010

 9

Board Certified* Radiologist

Credentialed by ARRT in CT

10011
10012

 9

Board Certified* Radiologist

Credentialed by ARRT in MRI

10021

 9

Board Certified* Physician

N/A

19081
19082
19083
19084
19085
19086

 9

Board Certified* Radiologist or Surgeon

State 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: MRI

27369

9

Board Certified* Radiologist or Orthopedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R or ARRT: R.T.-CT or R.T.- MR or ARMRIT: MRI

27648

9

Board Certified* Radiologist, Orthopedist or Podiatrist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

36901

9

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

43754
43755

9

Board Certified* Gastroenterologist

RN

47531
47532

9

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

47544

9

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

51725

2

Board Certified* Urologist

Urology or OB/GYN Personally Trained Staff

51726
51727
51728
51729

2

Board Certified* Urologist

Urology or OB/GYN Personally Trained Staff

51736

2

Board Certified* Urologist

Urology or OB/GYN Personally Trained Staff

51741

2

Board Certified* Urologist

Urology or OB/GYN Personally Trained Staff

51784

2

Board Certified* Urologist, Neurologist or Physiatrist

Urology or OB/GYN Personally Trained Staff

51785

3

Board Certified* Urologist, Neurologist or Physiatrist

Urology or OB/GYN Personally Trained Staff

51792

2

Board Certified* Urologist, Neurologist or Physiatrist

Urology or OB/GYN Personally Trained Staff

51797

2

Board Certified* Urologist

Urology or OB/GYN Personally Trained Staff

54240

2

Board Certified* Urologist

Credentialed by ARDMS: RVT or CCI: RVS

54250

1

Board Certified* Urologist

Credentialed by ARDMS: RVT or CCI: RVS

59025

1

Board Certified* Obstetrics/Gynecology

RN

70010

9

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70015

3

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70030

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70100
70110

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70120
70130

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70134

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70140
70150

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70160

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70170

3

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70190
70200

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70210
70220

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70240

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70250
70260

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70300
70310
70320

1

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70328
70330

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70332

3

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Credentialed by ARRT: R.T.-R

70336

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

70350

1

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

70355

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Credentialed by ARRT: R.T.-R

70360

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70370

3

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70371

3

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70380

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

70390

3

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Credentialed by ARRT: R.T.-R

70450

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

70460
70470

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

70480

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

70481
70482

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

70486

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

70487
70488

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

70490

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

70491
70492

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

70496
70498

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

70540

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

70542
70543

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

70544

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

70545
70546

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

70547

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

70548
70549

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

70551

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

70552
70553

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

71045
71046
71047
71048

1

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

71100
71101
71110
71111
71120
71130

1

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

71250

1

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

71260
71270

2

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

71271

9

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

71275

2

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

71550

1

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

71551
71552
71555

2

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72020
72040
72050
72052
72070
72072
72074
72080
72081
72082
72083
72084
72100
72110
72114
72120

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

72125

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

72126
72127

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

72128

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

72129
72130

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

72131

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

72132
72133

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

72141

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

72142

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

72146

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

72147

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

72148

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

72149

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

72156
72157
72158

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

72159

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

72170
72190

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

72191

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

72192

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

72193
72194

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

72195

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

72196
72197

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

72198

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

72200
72202
72220

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

72240
72255
72265
72270

3

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

72285
72295

3

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73000
73010
73020
73030

1

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73040

3

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73050
73060
73070
73080

1

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73085

3

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73090
73092
73100
73110

1

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73115

3

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73120
73130
73140

1

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73200

1

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

73201
73202
73206

2

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

73218

1

Board Certified* Radiologist or Orthopaedic Surgeon

Credentialed by ARRT: MR or ARMRIT: MRI

73219
73220

2

Board Certified* Radiologist or Orthopaedic Surgeon

Credentialed by ARRT: MR or ARMRIT: MRI

73221

1

Board Certified* Radiologist or Orthopaedic Surgeon

Credentialed by ARRT: MR or ARMRIT: MRI

73222
73223

2

Board Certified* Radiologist or Orthopaedic Surgeon

Credentialed by ARRT: MR or ARMRIT: MRI

73225

2

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

73501
73502
73503
73521
73522
73523

1

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73525

3

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73551
73552

1

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73560

1

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73562

9

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73564
73565

1

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73580

3

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73590

1

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73592

1

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73600
73610

1

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73615

3

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73620
73630
73650
73660

1

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

73700

1

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

73701
73702
73706

2

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

73718

1

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

73719
73720

2

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

73721

1

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

73722
73723

2

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

73725

2

Board Certified* Radiologist, Orthopaedic Surgeon or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

74018
74019
74021

1

Board Certified* Radiologist or Urologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

74022

1

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

74150

1

Board Certified* Radiologist or Urologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

74160
74170

2

Board Certified* Radiologist or Urologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

74174

2

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

74175

2

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

74176

1

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

74177
74178

2

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

74181

1

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

74182
74183

2

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

74185

2

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

74190

3

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

74210
74220
74221

3

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74230

3

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74240

3

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74246

3

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74248

3

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74250

2

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74251

3

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74261

2

Board Certified* Gastroenterologist or Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-C.T.

74262

2

Board Certified* Gastroenterologist or Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-C.T.

74270
74280

3

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74290

1

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74300
74301

3

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74328
74329
74330

3

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74400
74410
74415

2

Board Certified* Radiologist or Urologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74420

3

Board Certified* Radiologist or Urologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74425

3

Board Certified* Radiologist or Urologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74430

3

Board Certified* Radiologist or Urologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74440

3

Board Certified* Radiologist or Urologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74445

3

Board Certified* Radiologist or Urologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74450
74455

3

Board Certified* Radiologist or Urologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74470

3

Board Certified* Radiologist or Urologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

74710

1

Board Certified* Radiologist or Urologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

74712
74713

2

Board Certified* Radiologist or Gynecologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

74740

3

Board Certified* Radiologist or Gynecologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

74742

3

Board Certified* Radiologist or Gynecologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

74775

3

Board Certified* Radiologist or Gynecologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75557

1

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

75559

2

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

75561

1

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

75563

1

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

75565

1

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

75571

9

Board Certified* Cardiologist or Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

75572
75573
75574

2

Board Certified* Cardiologist or Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

75600
75605
75625
75630

3

Board Certified* Radiologist or Vascular Surgeon

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75635

2

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

75705

3

Board Certified* Radiologist or Vascular Surgeon OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75710
75716

3

Board Certified* Radiologist, Cardiologist or Vascular Surgeon

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75726
75731
75733
75736
75741
75743
75746
75756

3

Board Certified* Radiologist or Vascular Surgeon

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75774

3

Board Certified* Radiologist or Vascular Surgeon OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75801
75803
75805
75807

3

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75809

3

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75810

3

Board Certified* Radiologist or Vascular Surgeon

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75820
75822

3

Board Certified* Radiologist or Vascular Surgeon

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75825
75827

3

Board Certified* Radiologist or Vascular Surgeon

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75831
75833
75840
75842

3

Board Certified* Radiologist or Vascular Surgeon

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75860
75870
75872
75880

 3

Board Certified* Radiologist or Vascular Surgeon OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Credentialed by ARRT: R.T.-R

75885
75887
75889
75891

3

Board Certified* Radiologist or Vascular Surgeon

State License: General Radiographer or Credentialed by ARRT: R.T.-R

76000

3

Board Certified* Radiologist or Urologist or in the field related to the Primary Procedure

State License: General Radiographer or Credentialed by ARRT: R.T.-R

76010

1

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

76080

3

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Credentialed by ARRT: R.T.-R

76098

1

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

76100

1

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

76120
76125

2

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R

76376

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT or ARRT: MR or ARMRIT: MRI or ARDMS: RDMS or ARRT: R.T.-S (as applicable)

76377

3

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT or ARRT: MR or ARMRIT: MRI or ARDMS: RDMS or ARRT: R.T.-S (as applicable)

76380

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

76390

1

Board Certified* Radiologist OR Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

76391

2

Board Certified* Radiologist or Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: MR or ARMRIT: MRI

76506

1

Board Certified* Radiologist or Neurologist

Credentialed by ARDMS: RDMS-NE or ARRT: R.T.-S

76510
76511
76512
76513

2

Board Certified* Ophthalmologist, Radiologist or Optometrist

Credentialed by ARDMS: RDMS-OP or JCAHPO: COT or COMT

76514

1

Board Certified* Ophthalmologist, Radiologist or Optometrist

Credentialed by ARDMS: RDMS-OP or JCAHPO: COT or COMT

76516

1

Board Certified* Ophthalmologist, Radiologist or Optometrist

Credentialed by ARDMS: ROUB or RDMS- OP or JCAHPO: COT or COMT

76519

1

Board Certified* Ophthalmologist, Radiologist or Optometrist

Credentialed by ARDMS: ROUB or RDMS- OP or JCAHPO: COT or COMT

76529

1

Board Certified* Ophthalmologist or Radiologist

Credentialed by ARDMS: ROUB or RDMS- OP or JCAHPO: COT or COMT

76536

1

Board Certified* Radiologist or Neurologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76604

1

Board Certified* Radiologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76641
76642

1

Board Certified* Radiologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-BS

76700

1

Board Certified* Radiologist or Urologist

Credentialed by ARDMS RDMS or ARRT: R.T.-S

76705

1

 Board Certified* Radiologist or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76706

9

Board Certified* Cardiologist or Radiologist

ARDMS: RVT or RDMS or ARRT: R.T.-S or R.T.-VS or CCI: RVS

76770
76775
76776

1

Board Certified* Radiologist or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76801
76802
76805
76810
76811
76812
76813
76814
76815
76816
76817
76818
76819
76820
76821
76825
76826
76827
76828

1

Board Certified* Radiologist or Obstetrics/Gynecologist with Subspecialty Certification in Maternal Fetal Medicine

Credentialed by ARDMS: RDMS- OB/GYN or ARRT: R.T.-S

76830

1

Board Certified* Radiologist or Urologist

Credentialed by ARDMS: RDMS- OB/GYN or ARRT: R.T.-S

76831

3

Board Certified* Radiologist

Credentialed by ARDMS: RDMS- OB/GYN or ARRT: R.T.-S

76856
76857

1

Board Certified* Radiologist, Urologist or Obstetrics/Gynecologist

Credentialed by ARDMS: RDMS- OB/GYN or ARRT: R.T.-S

76870
76872

1

Board Certified* Radiologist or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76873

2

Board Certified* Radiologist or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76881
76882

1

Board Certified* Radiologist or Podiatrist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76883

9

Board Certified* Radiologist or Podiatrist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76885
76886

1

Board Certified* Radiologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76942

3

Board Certified* Radiologist, Podiatrist, or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76946

3

Board Certified* Radiologist

Credentialed by ARDMS: RDMS- OB/GYN or ARRT: R.T.-S

76975

3

Board Certified* Radiologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76977

1

Board Certified* Radiologist, Podiatrist, or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S or- BD

76978
76979

3

Board Certified* Radiologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

77002
77003

3

Board Certified* Radiologist or in the field related to the Primary Procedure

State License: General Radiographer or Credentialed by ARRT: R.T.-R

77012

3

Board Certified* Radiologist, Podiatrist, or Urologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

77014

2

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

77021

3

Board Certified* Radiologist or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

77046
77047

2

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

77048
77049

2

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

77053
77054

3

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-M

77063

9

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-M

77065
77066

9

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-M

77067

9

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-M

77071

3

Board Certified* Radiologist or Podiatrist

Physician Service Code-Must be performed by a physician

77072
77073
77074
77075
77076

1

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

77077

1

Board Certified* Radiologist or Podiatrist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

77078

1

Board Certified* Radiologist or Urologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-CT

77080
77081

1

Board Certified* Radiologist, Internal Medicine Specialist, Urologist or Orthopaedic Surgeon

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-BD or ISCD: CBDT

77084

1

Board Certified* Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

77085

1

Board Certified* Radiologist, Internal Medicine Specialist, Urologist or Orthopaedic Surgeon

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-BD or ISCD: CBDT

77086

1

Board Certified* Radiologist, Internal Medicine Specialist, or Orthopaedic Surgeon

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-BD or ISCD: CBDT

77417

1

Board Certified* Radiologist

State License: General Radiographer or Medical Physicist or Credentialed by ARRT: R.T.-R

78012
78013
78014

9

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78015
78016
78018

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78020

9

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78070

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78071
78072

9

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78075

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78102
78103
78104
78110
78111
78120
78121
78122
78130
78140
78185
78191
78195

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78201
78202

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78215
78216
78226
78227
78230
78231
78232
78258
78261
78262

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78264
78265
78266

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78267
78268

9

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78278
78282
78290
78291

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78300
78305

1

Board Certified* Nuclear Medicine or Radiology or Podiatrist

Credentialed by ARRT: N or NMTCB: CNMT

78306

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78315

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78350

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78414

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78428
78429
78430
78431
78432
78433
78434

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78445

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78451
78452
78453
78454

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78456

9

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78457
78458

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78459

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78466
78468
78469
78472
78473
78481
78483

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78491

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78492

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78494

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78496

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78579
78580
78582
78597
78598

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78600
78601
78605
78606

1

Board Certified* Nuclear Medicine or Radiology or Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: N or NMTCB CNMT

78608
78610
78630
78635
78645

1

Board Certified* Nuclear Medicine or Radiology or Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: N or NMTCB: CNMT

78650
78660

1

Board Certified* Nuclear Medicine or Radiology or Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: N or NMTCB: CNMT

78700
78701
78707
78708
78709

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78725

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78730
78740
78761

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78800
78801
78802
78803
78804

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78811

1

Board Certified* Nuclear Medicine, Radiology or Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: N or NMTCB: CNMT

78812
78813

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78814

1

Board Certified* Nuclear Medicine, Radiology or Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARRT: N or NMTCB: CNMT

78815
78816

1

Board Certified* Nuclear Medicine or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78830
78831
78832

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

78835

1

Board Certified* Nuclear Medicine or Cardiology or Radiology

Credentialed by ARRT: N or NMTCB: CNMT

91010
91020
91022
91030
91034
91035
91037
91038
91040

2

Board Certified* Gastroenterologist

RN

91065
91113

9

Board Certified* Gastroenterologist

RN

91120
91122

2

Board Certified* Gastroenterologist Colorectal Surgeon

RN

91132

1

Board Certified* Gastroenterologist

RN

91133

3

Board Certified* Gastroenterologist

RN

92060
92081
92082
92083

1

Board Certified* Ophthalmologist, Neurologist or Optometrist

Credentialed by JCAHPO: COT or COMT

92100

9

Board Certified* Ophthalmologist or Optometrist

Physician Service Code-Must be performed by a physician

92132
92133
92134

1

Board Certified* Ophthalmologist or Optometrist

Credentialed by JCAHPO: COT or COMT

92136
92229

9

Board Certified* Ophthalmologist or Optometrist

Credentialed by JCAHPO: COT or COMT

92235
92240
92242

2

Board Certified* Ophthalmologist, Neurologist or Optometrist

Credentialed by JCAHPO: COT or COMT

92250

1

Board Certified* Ophthalmologist, Neurologist or Optometrist

Credentialed by JCAHPO: COT or COMT

92265

3

Board Certified* Ophthalmologist, Neurologist, Physiatrist or Optometrist

Credentialed by JCAHPO: COT or COMT

92270
92273
92274
92283
92284
92285

1

Board Certified* Ophthalmologist, Neurologist or Optometrist

Credentialed by JCAHPO: COT or COMT

92286

1

Board Certified* Ophthalmologist, Neurologist or Optometrist

Credentialed by JCAHPO: COT or COMT or OPS: CRA

92517
92518
92519

 

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92537
92538
92540
92541
92542
92544
92545
92546
92547
92548
92549

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92550

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92552
92553
92555
92556

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92557

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92562
92563
92565

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92567
92568

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92570

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92571
92572
92575
92576
92577

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92579

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92582
92583
92584

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92587
92588

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92596

9

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92597

9

Board Certified* Neurologist or Otolaryngologist

Physician service code-must be performed by a physician

92601
92602
92603
92604

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*

92620
92621
92625

2

Board Certified* Neurologist or Otolaryngologist

Licensed Audiologist*


92651
92652
92653

 

2

Board Certified* Neurologist, Physiatrist or Otolaryngologist

Licensed Audiologist*

93000
93005

1

Board Certified* Internist or Cardiologist

RN, LPN/LVN, or State licensed Paramedic or Credentialed by CCI: CCT or NHA: CET

93010

9

Board Certified* Internist or Cardiologist

Professional component only code-must be performed by a physician

93015
93016
93017

2

Board Certified* Internist, Cardiologist or Nuclear Medicine - ACLS certified

RN, State licensed Paramedic or Credentialed by CCI: CCT or NHA: CET or ARRT: R.T.-N or NMTCB: CNMT

93018

9

Board Certified* Cardiologist or Nuclear Medicine

Professional component only code-must be performed by a physician

93024

3

Board Certified* Internist or Cardiologist - ACLS certified

RN, State licensed Paramedic or Credentialed by CCI: CCT or NHA: CET

93025

1

Board Certified* Internist or Cardiologist - ACLS certified

RN, State licensed Paramedic or Credentialed by CCI: CCT or NHA: CET

93040
93041

1

Board Certified* Internist or Cardiologist

RN, State licensed Paramedic or Credentialed by CCI: CCT or NHA: CET

93042

9

Board Certified* Cardiologist

Professional component code-must be performed by a physician

93224
93225
93226

1

Board Certified* Cardiologist

RN, State licensed Paramedic or Credentialed by CCI: CCT or NHA: CET

93227

9

Board Certified* Cardiologist

Professional component only code-must be performed by a physician

93228

9

Board Certified* Cardiologist

Professional component only code–service must be performed by a physician

93229

1

Board Certified* Cardiologist

State Licensed: RN or Paramedic or Credentialed by CCI: CCT or CRAT or NHA: CET

93241
93242
93243

1

Board Certified* Cardiologist

RN, State licensed Paramedic or Credentialed by CCI: CCT or CRAT or NHA: CET
93244

9

Board Certified* Cardiologist

Professional component only code-must be performed by a physician
93245
93246
93247

1

Board Certified* Cardiologist

RN, State licensed Paramedic or Credentialed by CCI: CCT or NHA: CET
93248

9

Board Certified* Cardiologist

Professional component only code - must be performed by a physician

93260
93261

2

Board Certified* Cardiologist

State Licensed: RN or Paramedic, or Credentialed by CCI: CCT or NHA: CET

93268
93270
93271

1

Board Certified* Cardiologist

RN, State licensed Paramedic or Credentialed by CCI: CCT or NHA: CET

93272

9

Board Certified* Cardiologist

Professional component only code-must be performed by a physician

93278

1

Board Certified* Cardiologist

RN, State licensed Paramedic or Credentialed by CCI: CCT or NHA: CET

93279
93280
93281
93282
93283
93284
93285
93286
93287
93288
93289
93290
93291
93292

2

Board Certified* Cardiologist

State Licensed: RN or Paramedic, or Credentialed by CCI: CCT or NHA: CET

93293

1

Board Certified* Cardiologist

State Licensed: RN or Paramedic, or Credentialed by CCI: CCT or NHA: CET

93294
93295

9

Board Certified* Cardiologist

Professional component only code – service must be performed by a physician

93296

1

Board Certified* Cardiologist

State Licensed: RN or Paramedic, or Credentialed by CCI: CCT or NHA: CET

93297
93298

9

Board Certified* Cardiologist

Professional component only code – service must be performed by a physician

93303
93304
93306
93307
93308

1

Board Certified* Cardiologist

Credentialed by ARDMS: RDCS or CCI: RCS

93312

3

Board Certified* Cardiologist

Credentialed by ARDMS: RDCS or CCI: RCS

93313

3

Board Certified* Cardiologist

Physician Service Code-must be performed by a physician

93314
93315

3

Board Certified* Cardiologist

Credentialed by ARDMS: RDCS or CCI: RCS

93316

3

Board Certified* Cardiologist

Physician Service Code-must be performed by a physician

93317

3

Board Certified* Cardiologist

Credentialed by ARDMS: RDCS or CCI: RCS

93319

9

Board Certified* Cardiologist

Credentialed by ARDMS: RDCS or CCI: RCS

93320
93321

1

Board Certified* Cardiologist

Credentialed by ARDMS: RDCS or CCI: RCS

93325

1

Board Certified* Cardiologist or Obstetrics/Gynecologist with Subspecialty Certification in Maternal Fetal Medicine

Credentialed by ARDMS: RDCS or CCI: RCS

93350

2

Board Certified* Cardiologist

Credentialed by ARDMS: RDCS or CCI: RCS, RN or State licensed Paramedic

93351

2

Board Certified* Cardiologist

State Licensed RN or Paramedic, or Credentialed by ARDMS: RDCS or CCI: RCS

93352

9

Board Certified* Cardiologist

Physician service code – service must be performed by a physician

93451
93452
93453
93454
93455
93456
93457
93458
93459
93460
93461
93571
93572
93593
93594
93595
93596
93597
93598

3

Board Certified* Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3

Credentialed by: ARRT: CI or CCI: RCIS

93660

2

Board Certified* Cardiologist

Credentialed by NHA: CET or CCI: CCT, RCIS or RCS or ARDMS: RDCS or RN

93701

9

Board Certified* Cardiologist

Demonstrates Proficiency

93740

9

Board Certified* Cardiologist

Credentialed by CCI: CCT or NHA: CET, State licensed Paramedic or RN

93770

9

Board Certified*Cardiologist

Credentialed by CCI: CCT or NHA: CET, State licensed Paramedic or RN

93784
93786

1

Board Certified* Cardiologist, Internal Medicine or Family Practice

Credentialed by CCI: CCT or NHA: CET, State licensed Paramedic or RN

93788

9

Board Certified* Cardiologist, Internal Medicine or Family Practice

Credentialed by CCI: CCT or NHA: CET, State licensed Paramedic or RN

93790

9

Board Certified* Cardiologist, Internal Medicine or Family Practice

Professional component only code-must be performed by a physician

93880
93882

1

Board Certified* Radiologist, Neurologist, Cardiologist, Vascular Surgeon or Neurologist with ASN or UCNS: Neuroimaging Subspecialty Certification

Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS

93886
93888
93890
93892
93893

1

Board Certified* Radiologist, Neurologist, Cardiologist or Vascular Surgeon

Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS

93922
93923
93924
93925
93926

1

Board Certified* Radiologist, Cardiologist, Podiatrist or Vascular Surgeon

Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS

93930
93931
93970
93971

1

Board Certified* Radiologist, Cardiologist or Vascular Surgeon

Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS

93975
93976

1

Board Certified* Radiologist, Vascular Surgeon, Urologist or Obstetrics/Gynecologist

Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS

93978
93979

1

Board Certified* Radiologist or Vascular Surgeon

Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS

93980
93981
93985
93986

1

Board Certified* Radiologist, Urologist or Vascular Surgeon

Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS

93990

1

Board Certified* Radiologist or Vascular Surgeon

Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS

94010
94014
94015

1

Board Certified* Pulmonologist

State License: Respiratory Therapist or RN

94016

9

Board Certified* Pulmonologist

Professional component only code-must be performed by a physician

94060
94070

2

Board Certified* Pulmonologist

State License: Respiratory Therapist or RN

94150
94200
94375

1

Board Certified* Pulmonologist

State License: Respiratory Therapist

94450

2

Board Certified* Pulmonologist

State License: Respiratory Therapist

94452
94453

2

Board Certified* Pulmonologist

State License: Respiratory Therapist or RN

94617
94618
94619

1

Board Certified* Pulmonologist

State License: Respiratory Therapist or RN

94621

2

Board Certified* Pulmonologist

State License: Respiratory Therapist or RN

94664

2

Board Certified* Pulmonologist

State License: Respiratory Therapist or RN

94680
94681

2

Board Certified* Pulmonologist

State License: Respiratory Therapist

94690
94726
94727
94728
94729

1

Board Certified* Pulmonologist

State License: Respiratory Therapist

94760
94761
94762

1

Board Certified* Pulmonologist

Demonstrates proficiency

94772

1

Board Certified* Pulmonologist

State License: Respiratory Therapist

95028
95044
95052
95056

2

Board Certified* Otolaryngologist

RN

95060

3

Board Certified* Otolaryngologist, Ophthalmologist or Optometrist

RN

95065

3

Board Certified* Otolaryngologist

RN

95070

2

Board Certified* Otolaryngologist

RN

95700
95705
95706
95707
95708
95709
95710
95711
95712
95713
95714
95715
95716

  1 Board Certified* Neurologist Credentialed by ABRET: R. EEG T

95717
95718
95719
95720
95721
95722
95723
95724
95725
95726

 9 Board Certified* Neurologist Credentialed by ABRET: R. EEG T

95800
95801
95806

9

Physician Certified by ABSM or ABMS: Sleep Medicine OR ABFM, ABIM, ABOHNS, ABPN or AOA: Sleep Medicine Subspecialty Certification

Credentialed by BRPT: RPSGT or CPSGT, ABRET: R. EEG T. (Polysomnography) or NBRC: CRT, SDS or RRT

95782
95783
95805
95807
95808
95810
95811

1

Physician Certified by ABSM or ABMS: Sleep Medicine OR ABFM, ABIM, ABOHNS, ABPN or AOA: Sleep Medicine Subspecialty Certification

Credentialed by BRPT: RPSGT or CPSGT, ABRET: R. EEG T. (Polysomnography) or NBRC: CRT, SDS or RRT

95812
95813

1

Board Certified* Neurologist

Credentialed by ABRET: R. EEG T

95816
95819
95822

9

Board Certified* Neurologist

Credentialed by ABRET: R. EEG T

95824

1

Board Certified* Neurologist

Credentialed by ABRET: R. EEG T

95830

9

Board Certified* Neurologist

Physician service code-must be performed by a physician

95860
95861
95863
95864
95867
95868
95869
95870

6A

Board Certified* Neurologist; or Board Certified* Physical Medicine and Rehabilitation (PMR) Physician with additional certification by:

a) American Board of Electrodiagnostic Medicine,

b) Clinical Neurophysiology, or

c) American Board of Neurophysiology; or a Physical therapist who is certified by the American Board of Physical Therapy Specialties (ABPTS) as a qualified clinical electrophysiology specialist and is permitted to provide the service under state law.

Procedure must be personally performed by a qualified physician who may or may not be the supervising physician. The qualified performing physician when assisted must provide personal supervision during the performance of EMG test(s) to the IDTF technician providing assistance*. In addition, EMG procedures may be personally performed by a Physical Therapist (PT) with ABPTS certification and certification in this specific procedure.

*The following are considered appropriate credentials to assist a physician performing an EMG: AAET: R. NCS.T, ABEM: CNCT or State Licensed Physical Therapist with ABPTS certification.

95872

66

Board Certified* Neurologist; or Board Certified* Physical Medicine and Rehabilitation (PMR) Physician with additional certification by:

a) American Board of Electrodiagnostic Medicine,

b) Clinical Neurophysiology, or

c) American Board of Neurophysiology; or a Physical therapist who is certified by the American Board of Physical Therapy Specialties (ABPTS) as a qualified clinical electrophysiology specialist and is permitted to provide the service under state law.

Procedure must be personally performed by a qualified physician who may or may not be the supervising physician. The qualified performing physician when assisted must provide personal supervision during the performance of EMG test(s) to the IDTF technician providing assistance*. In addition, EMG procedures may be personally performed by a Physical Therapist (PT) with ABPTS certification and certification in this specific procedure.

*The following are considered appropriate credentials to assist a physician performing an EMG: AAET: R. NCS.T, ABEM: CNCT or State Licensed Physical Therapist with ABPTS certification.

95875

3

Board Certified* Neurologist or Physiatrist

Credentialed by ABRET: R. EP T.

95885
95886
95887

6A

Board Certified* Neurologist; or Board Certified* Physical Medicine and Rehabilitation (PMR) Physician with additional certification by:

a) American Board of Electrodiagnostic Medicine,

b) Clinical Neurophysiology, or

c) American Board of Neurophysiology; or a Physical therapist who is certified by the American Board of Physical Therapy Specialties (ABPTS) as a qualified clinical electrophysiology specialist and is permitted to provide the service under state law.

Procedure must be personally performed by a qualified physician who may or may not be the supervising physician. The qualified performing physician when assisted must provide personal supervision during the performance of EMG test(s) to the IDTF technician providing assistance*. In addition, EMG procedures may be personally performed by a Physical Therapist (PT) with ABPTS certification and certification in this specific procedure.

*The following are considered appropriate credentials to assist a physician performing an EMG: AAET: R. NCS.T, ABEM: CNCT or State Licensed Physical Therapist with ABPTS certification.

95905

1

Board Certified* Neurologist, Physiatrist or Podiatrist

Credentialed by AAET: R. NCS.T, ABRET: R. EP T. or State Licensed Physical Therapist with ABPTS certification or Qualified Physical Therapist or ABEM: CNCT

95907
95908
95909
95910
95911
95912

7A

Board Certified* Neurologist, Physiatrist or Podiatrist-General supervision level applies if PT not certified

Credentialed by AAET: R. NCS.T, ABRET: R. EP T. or State Licensed Physical Therapist with ABPTS certification or Qualified Physical Therapist or ABEM: CNCT

95913

7A

Board Certified* Neurologist or Physiatrist- General supervision level applies if PT not certified

Credentialed by AAET: R. NCS.T, ABRET: R. EP T. or State Licensed Physical Therapist with ABPTS certification or Qualified Physical Therapist or ABEM: CNCT

95919

1

Board Certified* Neurologist or Physiatrist

Credentialed by AAET: R. NCS.T

95921

2

Board Certified* Neurologist or Physiatrist

Credentialed by AAET: R. NCS.T

95922
95923

3

Board Certified* Neurologist or Physiatrist

Credentialed by AAET: R. NCS.T

95924

9

Board Certified* Neurologist or Physiatrist

Credentialed by AAET: R. NCS.T

95925

21

Board Certified* Neurologist or Physiatrist

Credentialed by ABRET: R. EPT or R. EEG T. or State Licensed Qualified Physical Therapist or ABPTS Physical Therapist

95926

21

Board Certified* Neurologist, Physiatrist or Podiatrist

Credentialed by ABRET: R. EPT or R. EEG T. or State Licensed Qualified Physical Therapist or ABPTS Physical Therapist

95927

21

Board Certified* Neurologist or Physiatrist

Credentialed by ABRET: R. EPT or R. EEG T. or State Licensed Qualified Physical Therapist or ABPTS Physical Therapist

95928
95929

9

Board Certified* Neurologist or Physiatrist

Credentialed by ABRET: R. EPT or R. EEG T.

95930

9

Board Certified* Neurologist, Physiatrist or appropriately trained Optometrist

Credentialed by ABRET: R. EPT or R. EEG T.

95933

7A

Board Certified* Neurologist or Physiatrist-General supervision level applies if PT not certified

Credentialed by AAET: R. NCS.T, State licensed Physical Therapist with ABPTS certification or Qualified Physical Therapist or ABEM: CNCT

95937

7A

Board Certified* Neurologist, Physiatrist or Podiatrist-General supervision level applies if PT not certified

Credentialed by AAET: R. NCS.T, State licensed Physical Therapist with ABPTS certification or Qualified Physical Therapist or ABEM: CNCT

95938
95939

21

Board Certified* Neurologist or Physiatrist

Credentialed by ABRET: R. EPT or R. EEG T. or State Licensed Qualified Physical Therapist or ABPTS Physical Therapist

95954

3

Board Certified* Neurologist

Credentialed by ABRET: R. EEG T

95957

1

Board Certified* Neurologist

Credentialed by ABRET: R. EEG T

95958

3

Board Certified* Neurologist

Credentialed by ABRET: R. EEG T

96105
96110

4

Board Certified* Psychiatrist, Clinical psychologist or qualified independent psychologist

Physician service code-must be performed by a physician

G0106

3

Board Certified* Gastroenterologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-N or NMTCB: CNMT

G0130

1

Board Certified* Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-BD

G0235

1

Board Certified* Nuclear Medicine or Radiology

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-N or NMTCB: CNMT

G0248

1

Board Certified* Cardiologist

RN

G0249

1

Board Certified* Cardiologist

Demonstrates Proficiency

G0279

9

Board Certified* Radiologist

State License: General Radiographer or Credentialed by ARRT: R.T.-R and ARRT: R.T.-M

G0398
G0399
G0400

9

Physician Certified by ABSM or ABMS: Sleep Medicine OR ABFM, ABIM, ABOHNS, ABPN or AOA: Sleep Medicine Subspecialty Certification

Credentialed by BRPT: RPSGT or CPSGT, ABRET: R. EEG T. (Polysomnography), NBRC: CRT, SDS or RRT

G2066

1

Board Certified* Cardiologist

State Licensed RN or Paramedic or CCI: CCT or CRAT or NHA: CET

Q0035

1

Board Certified* Cardiologist

Credentialed by CCI: CCT or NHA: CET, State licensed Paramedic or RN

 

*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 CY2022). 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.html


Key for IDTF Table Abbreviations

American Association of Electrodiagnostic Technologists (AAET)

http://www.aaet.info

Registered 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.org

ABFM: Sleep Medicine Subspecialty Certification

American Board of Internal Medicine (ABIM)

https://www.abim.org/certification/policies/internal-medicine-subspecialty-policies/sleep-medicine/

ABIM: Sleep Medicine Subspecialty Certification

American Board of Nuclear Medicine (ABNM)

http://www.abnm.org

American Board of Otolaryngology - Head and Neck Surgery (ABOHNS)

https://www.abohns.org/

ABOHNS: Sleep Medicine Subspecialty Certification

American Board of Psychiatry and Neurology (ABPN)

http://www.abpn.com

ABPN: Sleep Medicine Subspecialty Certification

American Board of Medical Specialties (ABMS)

http://www.abms.org

American Board of Physical Therapy Specialties (ABPTS)

https://specialization.apta.org

ABPTS Physical Therapist

American Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET)

http://www.abret.org/exam_info/eligibility.php

Registered Electroencephalographic technologist (R. EEG T.)

Registered Evoked Potential Technologist (R. EP T.)

American Board of Sleep Medicine (ABSM)

www.absm.org

American Osteopathic Association (AOA)

https://osteopathic.org

AOA Doctor of Osteopathic Medicine (D.O.)

American Registry of Diagnostic Medical Sonographers (ARDMS)

http://www.ardms.org

Registered 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 Technologist

American Society of Neuroimaging (ASN)

http://www.asnweb.org

ASN: Neuroimaging Subspecialty Certification

The 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

https://mail.opsweb.org/Certif/Certif.html

Certified 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.org

Certified 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


JW and JZ Modifiers

When 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 patient’s medical record.

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.

  • 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 Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. 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.
  3. 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.
  4. Medical record documentation maintained by the IDTF must include the information listed below and be available upon request:
    • Written order from the treating physician
    • Hard copy documentation of the test results and interpretation; and
    • The medical necessity (reason) for performing the diagnostic test(s). 
  5. 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. 
  6. 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. 
  7. 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). 

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
99999 Not Applicable
N/A

CPT/HCPCS Codes

Expand All | Collapse All

Group 1

(922 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

 Group 1 Codes
Code Description
10005 Fna bx w/us gdn 1st les
10006 Fna bx w/us gdn ea addl
10007 Fna bx w/fluor gdn 1st les
10008 Fna bx w/fluor gdn ea addl
10009 Fna bx w/ct gdn 1st les
10010 Fna bx w/ct gdn ea addl
10011 Fna bx w/mr gdn 1st les
10012 Fna bx w/mr gdn ea addl
10021 Fna bx w/o img gdn 1st les
19081 Bx breast 1st lesion strtctc
19082 Bx breast add lesion strtctc
19083 Bx breast 1st lesion us imag
19084 Bx breast add lesion us imag
19085 Bx breast 1st lesion mr imag
19086 Bx breast add lesion mr imag
27369 Njx cntrst kne arthg/ct/mri
27648 Injection for ankle x-ray
36901 Intro cath dialysis circuit
43754 Dx gastr intub w/asp spec
43755 Dx gastr intub w/asp specs
47531 Injection for cholangiogram
47532 Injection for cholangiogram
47544 Removal duct glbldr calculi
51725 Simple cystometrogram
51726 Complex cystometrogram
51727 Cystometrogram w/up
51728 Cystometrogram w/vp
51729 Cystometrogram w/vp&up
51736 Urine flow measurement
51741 Electro-uroflowmetry first
51784 Anal/urinary muscle study
51785 Anal/urinary muscle study
51792 Urinary reflex study
51797 Intraabdominal pressure test
54240 Penis study
54250 Penis study
59025 Fetal non-stress test
70010 Contrast x-ray of brain
70015 Contrast x-ray of brain
70030 X-ray eye for foreign body
70100 X-ray exam of jaw <4views
70110 X-ray exam of jaw 4/> views
70120 X-ray exam of mastoids
70130 X-ray exam of mastoids
70134 X-ray exam of middle ear
70140 X-ray exam of facial bones
70150 X-ray exam of facial bones
70160 X-ray exam of nasal bones
70170 X-ray exam of tear duct
70190 X-ray exam of eye sockets
70200 X-ray exam of eye sockets
70210 X-ray exam of sinuses
70220 X-ray exam of sinuses
70240 X-ray exam pituitary saddle
70250 X-ray exam of skull
70260 X-ray exam of skull
70300 X-ray exam of teeth
70310 X-ray exam of teeth
70320 Full mouth x-ray of teeth
70328 X-ray exam of jaw joint
70330 X-ray exam of jaw joints
70332 X-ray exam of jaw joint
70336 Magnetic image jaw joint
70350 X-ray head for orthodontia
70355 Panoramic x-ray of jaws
70360 X-ray exam of neck
70370 Throat x-ray & fluoroscopy
70371 Speech evaluation complex
70380 X-ray exam of salivary gland
70390 X-ray exam of salivary duct
70450 Ct head/brain w/o dye
70460 Ct head/brain w/dye
70470 Ct head/brain w/o & w/dye
70480 Ct orbit/ear/fossa w/o dye
70481 Ct orbit/ear/fossa w/dye
70482 Ct orbit/ear/fossa w/o&w/dye
70486 Ct maxillofacial w/o dye
70487 Ct maxillofacial w/dye
70488 Ct maxillofacial w/o & w/dye
70490 Ct soft tissue neck w/o dye
70491 Ct soft tissue neck w/dye
70492 Ct sft tsue nck w/o & w/dye
70496 Ct angiography head
70498 Ct angiography neck
70540 Mri orbit/face/neck w/o dye
70542 Mri orbit/face/neck w/dye
70543 Mri orbt/fac/nck w/o &w/dye
70544 Mr angiography head w/o dye
70545 Mr angiography head w/dye
70546 Mr angiograph head w/o&w/dye
70547 Mr angiography neck w/o dye
70548 Mr angiography neck w/dye
70549 Mr angiograph neck w/o&w/dye
70551 Mri brain stem w/o dye
70552 Mri brain stem w/dye
70553 Mri brain stem w/o & w/dye
71045 X-ray exam chest 1 view
71046 X-ray exam chest 2 views
71047 X-ray exam chest 3 views
71048 X-ray exam chest 4+ views
71100 X-ray exam ribs uni 2 views
71101 X-ray exam unilat ribs/chest
71110 X-ray exam ribs bil 3 views
71111 X-ray exam ribs/chest4/> vws
71120 X-ray exam breastbone 2/>vws
71130 X-ray strenoclavic jt 3/>vws
71250 Ct thorax dx c-
71260 Ct thorax dx c+
71270 Ct thorax dx c-/c+
71271 Ct thorax lung cancer scr c-
71275 Ct angiography chest
71550 Mri chest w/o dye
71551 Mri chest w/dye
71552 Mri chest w/o & w/dye
71555 Mri angio chest w or w/o dye
72020 X-ray exam of spine 1 view
72040 X-ray exam neck spine 2-3 vw
72050 X-ray exam neck spine 4/5vws
72052 X-ray exam neck spine 6/>vws
72070 X-ray exam thorac spine 2vws
72072 X-ray exam thorac spine 3vws
72074 X-ray exam thorac spine4/>vw
72080 X-ray exam thoracolmb 2/> vw
72081 X-ray exam entire spi 1 vw
72082 X-ray exam entire spi 2/3 vw
72083 X-ray exam entire spi 4/5 vw
72084 X-ray exam entire spi 6/> vw
72100 X-ray exam l-s spine 2/3 vws
72110 X-ray exam l-2 spine 4/>vws
72114 X-ray exam l-s spine bending
72120 X-ray bend only l-s spine
72125 Ct neck spine w/o dye
72126 Ct neck spine w/dye
72127 Ct neck spine w/o & w/dye
72128 Ct chest spine w/o dye
72129 Ct chest spine w/dye
72130 Ct chest spine w/o & w/dye
72131 Ct lumbar spine w/o dye
72132 Ct lumbar spine w/dye
72133 Ct lumbar spine w/o & w/dye
72141 Mri neck spine w/o dye
72142 Mri neck spine w/dye
72146 Mri chest spine w/o dye
72147 Mri chest spine w/dye
72148 Mri lumbar spine w/o dye
72149 Mri lumbar spine w/dye
72156 Mri neck spine w/o & w/dye
72157 Mri chest spine w/o & w/dye
72158 Mri lumbar spine w/o & w/dye
72159 Mr angio spine w/o&w/dye
72170 X-ray exam of pelvis
72190 X-ray exam of pelvis
72191 Ct angiograph pelv w/o&w/dye
72192 Ct pelvis w/o dye
72193 Ct pelvis w/dye
72194 Ct pelvis w/o & w/dye
72195 Mri pelvis w/o dye
72196 Mri pelvis w/dye
72197 Mri pelvis w/o & w/dye
72198 Mr angio pelvis w/o & w/dye
72200 X-ray exam si joints
72202 X-ray exam si joints 3/> vws
72220 X-ray exam sacrum tailbone
72240 Myelography neck spine
72255 Myelography thoracic spine
72265 Myelography l-s spine
72270 Myelogphy 2/> spine regions
72285 Discography cerv/thor spine
72295 X-ray of lower spine disk
73000 X-ray exam of collar bone
73010 X-ray exam of shoulder blade
73020 X-ray exam of shoulder
73030 X-ray exam of shoulder
73040 Contrast x-ray of shoulder
73050 X-ray exam of shoulders
73060 X-ray exam of humerus
73070 X-ray exam of elbow
73080 X-ray exam of elbow
73085 Contrast x-ray of elbow
73090 X-ray exam of forearm
73092 X-ray exam of arm infant
73100 X-ray exam of wrist
73110 X-ray exam of wrist
73115 Contrast x-ray of wrist
73120 X-ray exam of hand
73130 X-ray exam of hand
73140 X-ray exam of finger(s)
73200 Ct upper extremity w/o dye
73201 Ct upper extremity w/dye
73202 Ct uppr extremity w/o&w/dye
73206 Ct angio upr extrm w/o&w/dye
73218 Mri upper extremity w/o dye
73219 Mri upper extremity w/dye
73220 Mri uppr extremity w/o&w/dye
73221 Mri joint upr extrem w/o dye
73222 Mri joint upr extrem w/dye
73223 Mri joint upr extr w/o&w/dye
73225 Mr angio upr extr w/o&w/dye
73501 X-ray exam hip uni 1 view
73502 X-ray exam hip uni 2-3 views
73503 X-ray exam hip uni 4/> views
73521 X-ray exam hips bi 2 views
73522 X-ray exam hips bi 3-4 views
73523 X-ray exam hips bi 5/> views
73525 Contrast x-ray of hip
73551 X-ray exam of femur 1
73552 X-ray exam of femur 2/>
73560 X-ray exam of knee 1 or 2
73562 X-ray exam of knee 3
73564 X-ray exam knee 4 or more
73565 X-ray exam of knees
73580 Contrast x-ray of knee joint
73590 X-ray exam of lower leg
73592 X-ray exam of leg infant
73600 X-ray exam of ankle
73610 X-ray exam of ankle
73615 Contrast x-ray of ankle
73620 X-ray exam of foot
73630 X-ray exam of foot
73650 X-ray exam of heel
73660 X-ray exam of toe(s)
73700 Ct lower extremity w/o dye
73701 Ct lower extremity w/dye
73702 Ct lwr extremity w/o&w/dye
73706 Ct angio lwr extr w/o&w/dye
73718 Mri lower extremity w/o dye
73719 Mri lower extremity w/dye
73720 Mri lwr extremity w/o&w/dye
73721 Mri jnt of lwr extre w/o dye
73722 Mri joint of lwr extr w/dye
73723 Mri joint lwr extr w/o&w/dye
73725 Mr ang lwr ext w or w/o dye
74018 X-ray exam abdomen 1 view
74019 X-ray exam abdomen 2 views
74021 X-ray exam abdomen 3+ views
74022 X-ray exam complete abdomen
74150 Ct abdomen w/o dye
74160 Ct abdomen w/dye
74170 Ct abdomen w/o & w/dye
74174 Ct angio abd&pelv w/o&w/dye
74175 Ct angio abdom w/o & w/dye
74176 Ct abd & pelvis w/o contrast
74177 Ct abd & pelv w/contrast
74178 Ct abd & pelv 1/> regns
74181 Mri abdomen w/o dye
74182 Mri abdomen w/dye
74183 Mri abdomen w/o & w/dye
74185 Mri angio abdom w orw/o dye
74190 X-ray exam of peritoneum
74210 X-ray xm phrnx&/crv esoph c+
74220 X-ray xm esophagus 1cntrst
74221 X-ray xm esophagus 2cntrst
74230 X-ray xm swlng funcj c+
74240 X-ray xm upr gi trc 1cntrst
74246 X-ray xm upr gi trc 2cntrst
74248 X-ray sm int f-thru std
74250 X-ray xm sm int 1cntrst std
74251 X-ray xm sm int 2cntrst std
74261 Ct colonography dx
74262 Ct colonography dx w/dye
74270 X-ray xm colon 1cntrst std
74280 X-ray xm colon 2cntrst std
74290 Contrast x-ray gallbladder
74300 X-ray bile ducts/pancreas
74301 X-rays at surgery add-on
74328 X-ray bile duct endoscopy
74329 X-ray for pancreas endoscopy
74330 X-ray bile/panc endoscopy
74400 Urography iv +-kub tomog
74410 Urography nfs drip&/bolus
74415 Urography nfs drip&/bls w/nf
74420 Urography rtrgr +-kub
74425 Urography antegrade rs&i
74430 Contrast x-ray bladder
74440 X-ray male genital tract
74445 X-ray exam of penis
74450 X-ray urethra/bladder
74455 X-ray urethra/bladder
74470 X-ray exam of kidney lesion
74710 X-ray measurement of pelvis
74712 Mri fetal sngl/1st gestation
74713 Mri fetal ea addl gestation
74740 X-ray female genital tract
74742 X-ray fallopian tube
74775 X-ray exam of perineum
75557 Cardiac mri for morph
75559 Cardiac mri w/stress img
75561 Cardiac mri for morph w/dye
75563 Card mri w/stress img & dye
75565 Card mri veloc flow mapping
75571 Ct hrt w/o dye w/ca test
75572 Ct hrt w/3d image
75573 Ct hrt c+ strux cgen hrt ds
75574 Ct angio hrt w/3d image
75600 Contrast exam thoracic aorta
75605 Contrast exam thoracic aorta
75625 Contrast exam abdominl aorta
75630 X-ray aorta leg arteries
75635 Ct angio abdominal arteries
75705 Artery x-rays spine
75710 Artery x-rays arm/leg
75716 Artery x-rays arms/legs
75726 Artery x-rays abdomen
75731 Artery x-rays adrenal gland
75733 Artery x-rays adrenals
75736 Artery x-rays pelvis
75741 Artery x-rays lung
75743 Artery x-rays lungs
75746 Artery x-rays lung
75756 Artery x-rays chest
75774 Artery x-ray each vessel
75801 Lymph vessel x-ray arm/leg
75803 Lymph vessel x-ray arms/legs
75805 Lymph vessel x-ray trunk
75807 Lymph vessel x-ray trunk
75809 Nonvascular shunt x-ray
75810 Vein x-ray spleen/liver
75820 Vein x-ray arm/leg
75822 Vein x-ray arms/legs
75825 Vein x-ray trunk
75827 Vein x-ray chest
75831 Vein x-ray kidney
75833 Vein x-ray kidneys
75840 Vein x-ray adrenal gland
75842 Vein x-ray adrenal glands
75860 Vein x-ray neck
75870 Vein x-ray skull
75872 Vein x-ray skull epidural
75880 Vein x-ray eye socket
75885 Vein x-ray liver w/hemodynam
75887 Vein x-ray liver w/o hemodyn
75889 Vein x-ray liver w/hemodynam
75891 Vein x-ray liver
76000 Fluoroscopy <1 hr phys/qhp
76010 X-ray nose to rectum
76080 X-ray exam of fistula
76098 X-ray exam surgical specimen
76100 X-ray exam of body section
76120 Cine/video x-rays
76125 Cine/video x-rays add-on
76376 3d render w/intrp postproces
76377 3d render w/intrp postproces
76380 Cat scan follow-up study
76390 Mr spectroscopy
76391 Mr elastography
76506 Echo exam of head
76510 Oph us dx b-scan&quan a-scan
76511 Oph us dx quan a-scan only
76512 Oph us dx b-scan
76513 Oph us dx ant sgm us uni/bi
76514 Echo exam of eye thickness
76516 Echo exam of eye
76519 Echo exam of eye
76529 Echo exam of eye
76536 Us exam of head and neck
76604 Us exam chest
76641 Ultrasound breast complete
76642 Ultrasound breast limited
76700 Us exam abdom complete
76705 Echo exam of abdomen
76706 Us abdl aorta screen aaa
76770 Us exam abdo back wall comp
76775 Us exam abdo back wall lim
76776 Us exam k transpl w/doppler
76801 Ob us < 14 wks single fetus
76802 Ob us < 14 wks addl fetus
76805 Ob us >= 14 wks sngl fetus
76810 Ob us >= 14 wks addl fetus
76811 Ob us detailed sngl fetus
76812 Ob us detailed addl fetus
76813 Ob us nuchal meas 1 gest
76814 Ob us nuchal meas add-on
76815 Ob us limited fetus(s)
76816 Ob us follow-up per fetus
76817 Transvaginal us obstetric
76818 Fetal biophys profile w/nst
76819 Fetal biophys profil w/o nst
76820 Umbilical artery echo
76821 Middle cerebral artery echo
76825 Echo exam of fetal heart
76826 Echo exam of fetal heart
76827 Echo exam of fetal heart
76828 Echo exam of fetal heart
76830 Transvaginal us non-ob
76831 Echo exam uterus
76856 Us exam pelvic complete
76857 Us exam pelvic limited
76870 Us exam scrotum
76872 Us transrectal
76873 Echograp trans r pros study
76881 Us compl joint r-t w/img
76882 Us lmtd jt/fcl evl nvasc xtr
76883 Us nrv&acc strux 1xtr compre
76885 Us exam infant hips dynamic
76886 Us exam infant hips static
76942 Echo guide for biopsy
76946 Echo guide for amniocentesis
76975 Gi endoscopic ultrasound
76977 Us bone density measure
76978 Us trgt dyn mbubb 1st les
76979 Us trgt dyn mbubb ea addl
77002 Needle localization by xray
77003 Fluoroguide for spine inject
77012 Ct scan for needle biopsy
77014 Ct scan for therapy guide
77021 Mri guidance ndl plmt rs&i
77046 Mri breast c- unilateral
77047 Mri breast c- bilateral
77048 Mri breast c-+ w/cad uni
77049 Mri breast c-+ w/cad bi
77053 X-ray of mammary duct
77054 X-ray of mammary ducts
77063 Breast tomosynthesis bi
77065 Dx mammo incl cad uni
77066 Dx mammo incl cad bi
77067 Scr mammo bi incl cad
77071 X-ray stress view
77072 X-rays for bone age
77073 X-rays bone length studies
77074 X-rays bone survey limited
77075 X-rays bone survey complete
77076 X-rays bone survey infant
77077 Joint survey single view
77078 Ct bone density axial
77080 Dxa bone density axial
77081 Dxa bone density/peripheral
77084 Magnetic image bone marrow
77085 Dxa bone density study
77086 Fracture assessment via dxa
77417 Radiology port images(s)
78012 Thyroid uptake measurement
78013 Thyroid imaging w/blood flow
78014 Thyroid imaging w/blood flow
78015 Thyroid met imaging
78016 Thyroid met imaging/studies
78018 Thyroid met imaging body
78020 Thyroid met uptake
78070 Parathyroid planar imaging
78071 Parathyrd planar w/wo subtrj
78072 Parathyrd planar w/spect&ct
78075 Adrenal cortex & medulla img
78102 Bone marrow imaging ltd
78103 Bone marrow imaging mult
78104 Bone marrow imaging body
78110 Plasma volume single
78111 Plasma volume multiple
78120 Red cell mass single
78121 Red cell mass multiple
78122 Blood volume
78130 Red cell survival study
78140 Red cell sequestration
78185 Spleen imaging
78191 Platelet survival
78195 Lymph system imaging
78201 Liver imaging
78202 Liver imaging with flow
78215 Liver and spleen imaging
78216 Liver & spleen image/flow
78226 Hepatobiliary system imaging
78227 Hepatobil syst image w/drug
78230 Salivary gland imaging
78231 Serial salivary imaging
78232 Salivary gland function exam
78258 Esophageal motility study
78261 Gastric mucosa imaging
78262 Gastroesophageal reflux exam
78264 Gastric emptying imag study
78265 Gastric emptying imag study
78266 Gastric emptying imag study
78267 Breath tst attain/anal c-14
78268 Breath test analysis c-14
78278 Acute gi blood loss imaging
78282 Gi protein loss exam
78290 Meckels divert exam
78291 Leveen/shunt patency exam
78300 Bone imaging limited area
78305 Bone imaging multiple areas
78306 Bone imaging whole body
78315 Bone imaging 3 phase
78350 Bone mineral single photon
78414 Non-imaging heart function
78428 Cardiac shunt imaging
78429 Myocrd img pet 1 std w/ct
78430 Myocrd img pet rst/strs w/ct
78431 Myocrd img pet rst&strs ct
78432 Myocrd img pet 2rtracer
78433 Myocrd img pet 2rtracer ct
78434 Aqmbf pet rest & rx stress
78445 Vascular flow imaging
78451 Ht muscle image spect sing
78452 Ht muscle image spect mult
78453 Ht muscle image planar sing
78454 Ht musc image planar mult
78456 Acute venous thrombus image
78457 Venous thrombosis imaging
78458 Ven thrombosis images bilat
78459 Myocrd img pet single study
78466 Heart infarct image
78468 Heart infarct image (ef)
78469 Heart infarct image (3d)
78472 Gated heart planar single
78473 Gated heart multiple
78481 Heart first pass single
78483 Heart first pass multiple
78491 Myocrd img pet 1std rst/strs
78492 Myocrd img pet mlt rst&strs
78494 Heart image spect
78496 Heart first pass add-on
78579 Lung ventilation imaging
78580 Lung perfusion imaging
78582 Lung ventilat&perfus imaging
78597 Lung perfusion differential
78598 Lung perf&ventilat diferentl
78600 Brain image < 4 views
78601 Brain image w/flow < 4 views
78605 Brain image 4+ views
78606 Brain image w/flow 4 + views
78608 Brain imaging (pet)
78610 Brain flow imaging only
78630 Cerebrospinal fluid scan
78635 Csf ventriculography
78645 Csf shunt evaluation
78650 Csf leakage imaging
78660 Nuclear exam of tear flow
78700 Kidney imaging morphol
78701 Kidney imaging with flow
78707 K flow/funct image w/o drug
78708 K flow/funct image w/drug
78709 K flow/funct image multiple
78725 Kidney function study
78730 Urinary bladder retention
78740 Ureteral reflux study
78761 Testicular imaging w/flow
78800 Rp loclzj tum 1 area 1 d img
78801 Rp loclzj tum 2+area 1+d img
78802 Rp loclzj tum whbdy 1 d img
78803 Rp loclzj tum spect 1 area
78804 Rp loclzj tum whbdy 2+d img
78811 Pet image ltd area
78812 Pet image skull-thigh
78813 Pet image full body
78814 Pet image w/ct lmtd
78815 Pet image w/ct skull-thigh
78816 Pet image w/ct full body
78830 Rp loclzj tum spect w/ct 1
78831 Rp loclzj tum spect 2 areas
78832 Rp loclzj tum spect w/ct 2
78835 Rp quan meas single area
91010 Esophagus motility study
91020 Gastric motility studies
91022 Duodenal motility study
91030 Acid perfusion of esophagus
91034 Gastroesophageal reflux test
91035 G-esoph reflx tst w/electrod
91037 Esoph imped function test
91038 Esoph imped funct test > 1hr
91040 Esoph balloon distension tst
91065 Breath hydrogen/methane test
91113 Gi trc img intral colon i&r
91120 Rectal sensation test
91122 Anal pressure record
91132 Electrogastrography
91133 Electrogastrography w/test
92060 Special eye evaluation
92081 Visual field examination(s)
92082 Visual field examination(s)
92083 Visual field examination(s)
92100 Serial tonometry exam(s)
92132 Cmptr ophth dx img ant segmt
92133 Cmptr ophth img optic nerve
92134 Cptr ophth dx img post segmt
92136 Ophthalmic biometry
92229 Img rta detc/mntr ds poc aly
92235 Fluorescein angrph uni/bi
92240 Icg angiography uni/bi
92242 Fluorescein icg angiography
92250 Eye exam with photos
92265 Eye muscle evaluation
92270 Electro-oculography
92273 Full field erg w/i&r
92274 Multifocal erg w/i&r
92283 Color vision examination
92284 Dx dark adaptation exam i&r
92285 Eye photography
92286 Internal eye photography
92517 Vemp test i&r cervical
92518 Vemp test i&r ocular
92519 Vemp tst i&r cervical&ocular
92537 Caloric vstblr test w/rec
92538 Caloric vstblr test w/rec
92540 Basic vestibular evaluation
92541 Spontaneous nystagmus test
92542 Positional nystagmus test
92544 Optokinetic nystagmus test
92545 Oscillating tracking test
92546 Sinusoidal rotational test
92547 Supplemental electrical test
92548 Cdp-sot 6 cond w/i&r
92549 Cdp-sot 6 cond w/i&r mct&adt
92550 Tympanometry & reflex thresh
92552 Pure tone audiometry air
92553 Audiometry air & bone
92555 Speech threshold audiometry
92556 Speech audiometry complete
92557 Comprehensive hearing test
92562 Loudness balance test
92563 Tone decay hearing test
92565 Stenger test pure tone
92567 Tympanometry
92568 Acoustic refl threshold tst
92570 Acoustic immitance testing
92571 Filtered speech hearing test
92572 Staggered spondaic word test
92575 Sensorineural acuity test
92576 Synthetic sentence test
92577 Stenger test speech
92579 Visual audiometry (vra)
92582 Conditioning play audiometry
92583 Select picture audiometry
92584 Electrocochleography
92587 Evoked auditory test limited
92588 Evoked auditory tst complete
92596 Ear protector evaluation
92597 Oral speech device eval
92601 Cochlear implt f/up exam <7
92602 Reprogram cochlear implt <7
92603 Cochlear implt f/up exam 7/>
92604 Reprogram cochlear implt 7/>
92620 Auditory function 60 min
92621 Auditory function + 15 min
92625 Tinnitus assessment
92651 Aep hearing status deter i&r
92652 Aep thrshld est mlt freq i&r
92653 Aep neurodiagnostic i&r
93000 Electrocardiogram complete
93005 Electrocardiogram tracing
93010 Electrocardiogram report
93015 Cardiovascular stress test
93016 Cardiovascular stress test
93017 Cardiovascular stress test
93018 Cardiovascular stress test
93024 Cardiac drug stress test
93025 Microvolt t-wave assess
93040 Rhythm ecg with report
93041 Rhythm ecg tracing
93042 Rhythm ecg report
93224 Ecg monit/reprt up to 48 hrs
93225 Ecg monit/reprt up to 48 hrs
93226 Ecg monit/reprt up to 48 hrs
93227 Ecg monit/reprt up to 48 hrs
93228 Remote 30 day ecg rev/report
93229 Remote 30 day ecg tech supp
93241 Ext ecg>48hr<7d rec scan a/r
93242 Ext ecg>48hr<7d recording
93243 Ext ecg>48hr<7d scan a/r
93244 Ext ecg>48hr<7d rev&interpj
93245 Ext ecg>7d<15d rec scan a/r
93246 Ext ecg>7d<15d recording
93247 Ext ecg>7d<15d scan a/r
93248 Ext ecg>7d<15d rev&interpj
93260 Prgrmg dev eval impltbl sys
93261 Interrogate subq defib
93268 Ecg record/review
93270 Remote 30 day ecg rev/report
93271 Ecg/monitoring and analysis
93272 Ecg/review interpret only
93278 Ecg/signal-averaged
93279 Prgrmg dev eval pm/ldls pm
93280 Pm device progr eval dual
93281 Pm device progr eval multi
93282 Prgrmg eval implantable dfb
93283 Prgrmg eval implantable dfb
93284 Prgrmg eval implantable dfb
93285 Prgrmg dev eval scrms ip
93286 Peri-px eval pm/ldls pm ip
93287 Peri-px device eval & prgr
93288 Interrog evl pm/ldls pm ip
93289 Interrog device eval heart
93290 Interrog dev eval icpms ip
93291 Interrog dev eval scrms ip
93292 Wcd device interrogate
93293 Pm phone r-strip device eval
93294 Rem interrog evl pm/ldls pm
93295 Dev interrog remote 1/2/mlt
93296 Rem interrog evl pm/ids
93297 Rem interrog dev eval icpms
93298 Rem interrog dev eval scrms
93303 Echo transthoracic
93304 Echo transthoracic
93306 Tte w/doppler complete
93307 Tte w/o doppler complete
93308 Tte f-up or lmtd
93312 Echo transesophageal
93313 Echo transesophageal
93314 Echo transesophageal
93315 Echo transesophageal
93316 Echo transesophageal
93317 Echo transesophageal
93319 3d echo img cgen car anomal
93320 Doppler echo exam heart
93321 Doppler echo exam heart
93325 Doppler color flow add-on
93350 Stress tte only
93351 Stress tte complete
93352 Admin ecg contrast agent
93451 Right heart cath
93452 Left hrt cath w/ventrclgrphy
93453 R&l hrt cath w/ventriclgrphy
93454 Coronary artery angio s&i
93455 Coronary art/grft angio s&i
93456 R hrt coronary artery angio
93457 R hrt art/grft angio
93458 L hrt artery/ventricle angio
93459 L hrt art/grft angio
93460 R&l hrt art/ventricle angio
93461 R&l hrt art/ventricle angio
93571 Heart flow reserve measure
93572 Heart flow reserve measure
93593 R hrt cath chd nml nt cnj
93594 R hrt cath chd abnl nt cnj
93595 L hrt cath chd nm/abn nt cnj
93596 R&l hrt cath chd nml nt cnj
93597 R&l hrt cath chd abnl nt cnj
93598 Car outp meas drg cath chd
93660 Tilt table evaluation
93701 Bioimpedance cv analysis
93740 Temperature gradient studies
93770 Measure venous pressure
93784 Ambl bp mntr w/software
93786 Ambl bp mntr w/sw rec only
93788 Ambl bp mntr w/sw a/r
93790 Ambl bp mntr w/sw i&r
93880 Extracranial bilat study
93882 Extracranial uni/ltd study
93886 Intracranial complete study
93888 Intracranial limited study
93890 Tcd vasoreactivity study
93892 Tcd emboli detect w/o inj
93893 Tcd emboli detect w/inj
93922 Upr/l xtremity art 2 levels
93923 Upr/lxtr art stdy 3+ lvls
93924 Lwr xtr vasc stdy bilat
93925 Lower extremity study
93926 Lower extremity study
93930 Upper extremity study
93931 Upper extremity study
93970 Extremity study
93971 Extremity study
93975 Vascular study
93976 Vascular study
93978 Vascular study
93979 Vascular study
93980 Penile vascular study
93981 Penile vascular study
93985 Dup-scan hemo compl bi std
93986 Dup-scan hemo compl uni std
93990 Doppler flow testing
94010 Breathing capacity test
94014 Patient recorded spirometry
94015 Patient recorded spirometry
94016 Review patient spirometry
94060 Evaluation of wheezing
94070 Evaluation of wheezing
94150 Vital capacity test
94200 Lung function test (mbc/mvv)
94375 Respiratory flow volume loop
94450 Hypoxia response curve
94452 Hast w/report
94453 Hast w/oxygen titrate
94617 Exercise tst brncspsm w/ecg
94618 Pulmonary stress testing
94619 Exercise tst brncspsm wo ecg
94621 Cardiopulm exercise testing
94664 Evaluate pt use of inhaler
94680 Exhaled air analysis o2
94681 Exhaled air analysis o2/co2
94690 Exhaled air analysis
94726 Pulm funct tst plethysmograp
94727 Pulm function test by gas
94728 Airwy resist by oscillometry
94729 Co/membane diffuse capacity
94760 Measure blood oxygen level
94761 Measure blood oxygen level
94762 Measure blood oxygen level
94772 Breath recording infant
95028 Icut allergy test-delayed
95044 Allergy patch tests
95052 Photo patch test
95056 Photosensitivity tests
95060 Eye allergy tests
95065 Nose allergy test
95070 Bronchial allergy tests
95700 Eeg cont rec w/vid eeg tech
95705 Eeg w/o vid 2-12 hr unmntr
95706 Eeg wo vid 2-12hr intmt mntr
95707 Eeg w/o vid 2-12hr cont mntr
95708 Eeg wo vid ea 12-26hr unmntr
95709 Eeg w/o vid ea 12-26hr intmt
95710 Eeg w/o vid ea 12-26hr cont
95711 Veeg 2-12 hr unmonitored
95712 Veeg 2-12 hr intmt mntr
95713 Veeg 2-12 hr cont mntr
95714 Veeg ea 12-26 hr unmntr
95715 Veeg ea 12-26hr intmt mntr
95716 Veeg ea 12-26hr cont mntr
95717 Eeg phys/qhp 2-12 hr w/o vid
95718 Eeg phys/qhp 2-12 hr w/veeg
95719 Eeg phys/qhp ea incr w/o vid
95720 Eeg phy/qhp ea incr w/veeg
95721 Eeg phy/qhp>36<60 hr w/o vid
95722 Eeg phy/qhp>36<60 hr w/veeg
95723 Eeg phy/qhp>60<84 hr w/o vid
95724 Eeg phy/qhp>60<84 hr w/veeg
95725 Eeg phy/qhp>84 hr w/o vid
95726 Eeg phy/qhp>84 hr w/veeg
95782 Polysom <6 yrs 4/> paramtrs
95783 Polysom <6 yrs cpap/bilvl
95800 Slp stdy unattended
95801 Slp stdy unatnd w/anal
95805 Multiple sleep latency test
95806 Sleep study unatt&resp efft
95807 Sleep study attended
95808 Polysom any age 1-3> param
95810 Polysom 6/> yrs 4/> param
95811 Polysom 6/>yrs cpap 4/> parm
95812 Eeg 41-60 minutes
95813 Eeg extnd mntr 61-119 min
95816 Eeg awake and drowsy
95819 Eeg awake and asleep
95822 Eeg coma or sleep only
95824 Eeg cerebral death only
95830 Insert electrodes for eeg
95860 Muscle test one limb
95861 Muscle test 2 limbs
95863 Muscle test 3 limbs
95864 Muscle test 4 limbs
95867 Muscle test cran nerv unilat
95868 Muscle test cran nerve bilat
95869 Muscle test thor paraspinal
95870 Muscle test nonparaspinal
95872 Muscle test one fiber
95875 Limb exercise test
95885 Musc tst done w/nerv tst lim
95886 Musc test done w/n test comp
95887 Musc tst done w/n tst nonext
95905 Motor &/ sens nrve cndj test
95907 Nvr cndj tst 1-2 studies
95908 Nrv cndj tst 3-4 studies
95909 Nrv cndj tst 5-6 studies
95910 Nrv cndj test 7-8 studies
95911 Nrv cndj test 9-10 studies
95912 Nrv cndj test 11-12 studies
95913 Nrv cndj test 13/> studies
95919 Quan puplmtry phy/qhp uni/bi
95921 Autonomic nrv parasym inervj
95922 Autonomic nrv adrenrg inervj
95923 Autonomic nrv syst funj test
95924 Ans parasymp & symp w/tilt
95925 Somatosensory testing
95926 Somatosensory testing
95927 Somatosensory testing
95928 C motor evoked uppr limbs
95929 C motor evoked lwr limbs
95930 Visual ep test cns w/i&r
95933 Blink reflex test
95937 Neuromuscular junction test
95938 Somatosensory testing
95939 C motor evoked upr&lwr limbs
95954 Eeg monitoring/giving drugs
95957 Eeg digital analysis
95958 Eeg monitoring/function test
96105 Assessment of aphasia
96110 Developmental screen w/score
G0106 Colon ca screen;barium enema
G0130 Single energy x-ray study
G0235 Pet not otherwise specified
G0248 Demonstrate use home inr mon
G0249 Provide inr test mater/equip
G0279 Tomosynthesis, mammo
G0398 Home sleep test/type 2 porta
G0399 Home sleep test/type 3 porta
G0400 Home sleep test/type 4 porta
G2066 Inter devc remote 30d
Q0035 Cardiokymography
0501T Cor ffr derived cor cta data
0502T Cor ffr data prep & transmis
0503T Cor ffr alys gnrj ffr mdl
0504T Cor ffr data review i&r
0508T Pls echo us b1 dns meas tib
0509T Pattern erg w/i&r
0554T B1 str & fx rsk analysis
0555T B1 str&fx rsk transmis data
0556T B1 str & fx rsk assessment
0557T B1 str & fx rsk i&r
0558T Ct scan f/biomchn ct alys
0604T Rem oct rta dev setup&educaj
0605T Rem oct rta techl sprt min 8
0606T Rem oct rta phys/qhp ea 30d
0607T Rem mntr pulm flu mntr setup
0608T Rem mntr pulm flu mntr alys
0609T Mrs disc pain acquisj data
0610T Mrs disc pain transmis data
0611T Mrs disc pain alg alys data
0612T Mrs discogenic pain i&r
0615T Eye mvmt alys w/o calbrj i&r
0648T Quan mr tis wo mri 1orgn
0649T Quan mr tiss w/mri 1orgn
0683T Prgrmg dev eval isdss ip
0685T Interrog dev eval isdss ip
0689T Quan us tis charac w/o dx us
0690T Quan us tis charac w/dx us
0694T 3d vol img&rcnstj brst/ax
0696T Bdy surf mapg pm/cvdfb f/up
0697T Quan mr tis wo mri mlt orgn
0698T Quan mr tiss w/mri mlt orgn
0723T Qmrcp w/o dx mri sm anat ses
0724T Qmrcp w/dx mri same anatomy
0742T Aqmbf spect xers/strs & rest
0764T Asstv alg ecg rsk asmt cncrt
0765T Asstv alg ecg rsk asmt prev
0779T Gi myoelectrical actv study
0804T Prgrmg evl ldls pm 2chmbr ip

Group 2

(85 Codes)
Group 2 Paragraph

Note: Positron emission tomography (PET) Radiopharmaceutical/Tracer codes A9597 or A9598 should only be used when there is no existing dedicated PET tracer code available.  For additional information please refer to A59049 NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions.

 Group 2 Codes
Code Description
36415 Routine venipuncture
A9500 Tc99m sestamibi
A9501 Technetium tc-99m teboroxime
A9502 Tc99m tetrofosmin
A9503 Tc99m medronate
A9504 Tc99m apcitide
A9505 Tl201 thallium
A9507 In111 capromab
A9508 I131 iodobenguate, dx
A9509 Iodine i-123 sod iodide mil
A9510 Tc99m disofenin
A9512 Tc99m pertechnetate
A9515 Choline c-11
A9516 Iodine i-123 sod iodide mic
A9521 Tc99m exametazime
A9526 Nitrogen n-13 ammonia
A9528 Iodine i-131 iodide cap, dx
A9537 Tc99m mebrofenin
A9539 Tc99m pentetate
A9540 Tc99m maa
A9541 Tc99m sulfur colloid
A9547 In111 oxyquinoline
A9548 In111 pentetate
A9550 Tc99m gluceptate
A9551 Tc99m succimer
A9552 F18 fdg
A9555 Rb82 rubidium
A9556 Ga67 gallium
A9558 Xe133 xenon 10mci
A9560 Tc99m labeled rbc
A9561 Tc99m oxidronate
A9562 Tc99m mertiatide
A9567 Technetium tc-99m aerosol
A9569 Technetium tc-99m auto wbc
A9570 Indium in-111 auto wbc
A9571 Indium in-111 auto platelet
A9572 Indium in-111 pentetreotide
A9573 Inj, gadopiclenol, 1 ml
A9575 Inj gadoterate meglumi 0.1ml
A9576 Inj prohance multipack
A9577 Inj multihance
A9578 Inj multihance multipack
A9579 Gad-base mr contrast nos,1ml
A9581 Gadoxetate disodium inj
A9583 Gadofosveset trisodium inj
A9584 Iodine i-123 ioflupane
A9585 Gadobutrol injection
A9586 Florbetapir f18
A9587 Gallium ga-68
A9588 Fluciclovine f-18
A9591 Fluoroestradiol f 18
A9592 Copper cu 64 dotatate diag
A9593 Gallium ga-68 psma-11 ucsf
A9594 Gallium ga-68 psma-11, ucla
A9595 Piflu f-18, dia 1 millicurie
A9596 Gallium illuccix 1 millicure
A9597 Pet, dx, for tumor id, noc
A9598 Pet dx for non-tumor id, noc
A9601 Flortaucipir inj 1 millicuri
A9602 Fluorodopa f-18 diag per mci
A9800 Gallium locametz 1 millicuri
J1020 Methylprednisolone 20 mg inj
J1030 Methylprednisolone 40 mg inj
J1040 Methylprednisolone 80 mg inj
J1200 Diphenhydramine hcl injectio
J1245 Dipyridamole injection
J1250 Inj dobutamine hcl/250 mg
J1610 Glucagon hydrochloride/1 mg
J1611 Inj glucagon hcl, fresenius
J1940 Furosemide injection
J2250 Inj midazolam hydrochloride
J2765 Metoclopramide hcl injection
J2785 Regadenoson injection
Q9950 Inj sulf hexa lipid microsph
Q9951 Locm >= 400 mg/ml iodine,1ml
Q9953 Inj fe-based mr contrast,1ml
Q9954 Oral mr contrast, 100 ml
Q9955 Inj perflexane lip micros,ml
Q9956 Inj octafluoropropane mic,ml
Q9957 Inj perflutren lip micros,ml
Q9965 Locm 100-199mg/ml iodine,1ml
Q9966 Locm 200-299mg/ml iodine,1ml
Q9967 Locm 300-399mg/ml iodine,1ml
Q9982 Flutemetamol f18 diagnostic
Q9983 Florbetaben f18 diagnostic
N/A

CPT/HCPCS Modifiers

Expand All | Collapse All

Group 1

Group 1 Paragraph

N/A

 Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Expand All | Collapse All

Group 1

(1 Code)
Group 1 Paragraph

N/A

 Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Expand All | Collapse All

Group 1

(1 Code)
Group 1 Paragraph

N/A

 Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Expand All | Collapse All

Group 1

Group 1 Paragraph

N/A

 Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
999x Not Applicable
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
99999 Not Applicable
N/A

Other Coding Information

Expand All | Collapse All

Group 1

Group 1 Paragraph

N/A

 Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2023 R17

Article revised and published on 10/05/2023 effective for dates of service on and after 10/01/2023 to reflect the October Quarterly CPT/HCPCS Update. The following HCPCS code has been added to the article: A9573 in Group 2 Codes.
07/20/2023 R16

Article revised and published on 07/20/2023 effective for dates of service on and after 07/20/2023 in response to an inquiry. The ‘Technician Qualification Requirements’ in the ‘Credentialing Matrix’ have been revised to change ‘State License: General Radiographer’ and ‘CRT-R to ‘State License: General Radiographer or Credentialed by ARRT: Radiography (R.T.-R).

The 2nd paragraph under the ‘Credentialing Matrix’ section has been revised to add additional medical specialty boards that are part of the ABMS and are included in the ‘Supervising Physician Qualification Requirements’ section of the ‘Credentialing Matrix’.

The ‘Technician Qualification Requirements’ have also been revised for the following CPT/HCPCS Codes: 0508T, 0607T, 0608T, 0764T-0765T, 76706, 92550, 92557, 92567-92568, 92570, 92579, 92601-92604, 93000, 93005, 93015-93017, 93229, 93241-93243, 95782-95783, 95800-95801, 95805, 95806, 95807, 95808, 95810, 95811, 95925-95927, 95938-95939, G0398-G0400 and G2066. An asterisk note has been added under the ‘Credentialing Matrix’ for Licensed Audiologist*.

The ‘Supervising Physician Qualification Requirements’ have been revised for the following CPT/HCPCS Codes: 0508T, 27369, 75774, 76706, 76801, 76802, 76805, 76810-76821, 76825-76828, 76856–76857, 93015-93017, 93018, 93325, 93975-93976, 95782-95783, 95800-95801, 95805, 95806, 95807, 95808, 95810, 95811, 95930 and G0398-G0400.

The following sections were added under the ‘Credentialing Matrix’: ‘Key for IDTF Table Abbreviations’ and ‘JW and JZ Modifiers’.

In response to the July Quarterly HCPCS/CPT Code Updates, the following code has been added to the ‘Credentialing Matrix’ with applicable levels of physician supervision and supervising physician and technician qualification requirements, and to the ‘CPT/HCPCS Codes’ section for ‘Group 1 Codes’: 0804T which became effective on 07/01/2023. Minor formatting changes have been made throughout the article.
01/01/2023 R15

Article revised and published on 01/26/2023 effective for dates of service on and after 01/01/2023 to reflect the Annual HCPCS/CPT Code Updates. The following CPT codes have been added to the ‘Credentialing Matrix’ with applicable levels of physician supervision and supervising physician and technician qualification requirements, and to the ‘CPT/HCPCS Codes’ section for ‘Group 1 Codes’: 76883, 95919, 0742T, 0764T, 0765T and 0779T. The following HCPCS code has been added to the 'CPT/HCPCS Codes' section for 'Group 2 Codes': J1611. For the following CPT codes either the short description and/or the long description was changed. Depending on which description is used in this article, there may not be any change in how the code displays: 76882, 78803, 78830, 78831, 78832, 92229 and 92284 in Group 1 Codes.
12/08/2022 R14

Article revised and published on 12/08/2022 in response to inquiries. CPT code 27648 has been added to the ‘Credentialing Matrix’ with Physician Supervision Level of 9; Supervising Physician Qualification Requirements - Board Certified Radiologist, Orthopedist or Podiatrist, and Technician Qualification Requirements - CRT-R. CPT code 27648 has also been added to the ‘CPT/HCPCS Codes’ for ‘Group 1 Codes’. The ‘Supervising Physician Qualification Requirements’ in the ‘Credentialing Matrix’ has been revised for CPT code 76681 and 76682 to add Board Certified Podiatrist.

CPT codes 0723T and 0724T have been added to the ‘Credentialing Matrix’ with Physician Supervision Level of 9, Supervising Physician Qualification Requirements – Board Certified Radiologist, Gastroenterologist or Hepatologist and Technician Qualification Requirements - ARRT: MR or ARMRIT: MRI. CPT codes 0723T and 0724T have also been added to the ‘CPT/HCPCS Codes’ for ‘Group 1 Codes’.
10/01/2022 R13

Article revised and published on 10/13/2022 effective for dates of service on and after 10/01/2022 to reflect the October Quarterly CPT/HCPCS Code Updates. The following HCPCS codes have been added to the ‘CPT/HCPCS Codes’ section for ‘Group 2’ codes: A9602 and A9800.

Please note that Revision History R12 below should read as:

Article revised and published on 9/29/2022. The following CPT/HCPCS codes have been added to the ‘Credentialing Matrix’ with applicable levels of physician supervision and supervising physician and technician qualification requirements, as well as to the CPT/HCPCS ‘Group 1 Codes:’ 95800, 95801, 95806, 0501T, 0502T, 0503T, and 0504T.

An additional note has been added in the ‘Article Text’ stating IDTFs performing sleep studies per LCD L33405 (Polysomnography and Sleep Testing), must also be an accredited sleep center or laboratory.
09/29/2022 R12

Article revised and published on 9/29/2022 effective for dates of service on and after 9/29/2022. The following CPT/HCPCS codes have been added to the ‘Credentialing Matrix’ with applicable levels of physician supervision and supervising physician and technician qualification requirements, as well as to the CPT/HCPCS ‘Group 1 Codes:’ 95800, 95801, 95806, 0501T, 0502T, 0503T, and 0504T.

An additional note has been added in the ‘Article Text’ stating IDTFs performing sleep studies per LCD L33405 (Polysomnography and Sleep Testing), must also be an accredited sleep center or laboratory.
07/01/2022 R11

Article revised and published on 08/04/2022 effective for dates of service on and after 07/01/2022 to reflect the July CPT/HCPCS Code Updates and response to an inquiry. HCPCS Codes have been added to ‘Group 1 Codes’ and the following HCPCS Codes have been added to ‘Group 2 Codes’: 36415, A9500, A9501, A9502, A9503, A9504, A9505, A9507, A9508, A9509, A9510, A9512, A9515, A9516, A9521, A9526, A9528, A9537, A9539, A9540, A9541, A9547, A9548, A9550, A9551, A9552, A9555, A9556, A9558, A9560, A9561, A9562, A9567, A9569, A9570, A9571, A9572, A9575, A9576, A9577, A9578, A9579, A9581, A9583, A9584, A9585, A9586, A9587, A9588, A9591, A9592, A9593, A9594, A9595, A9596, A9597, A9598, A9601, J1020, J1030, J1040, J1200, J1245, J1250, J1610, J1940, J2250, J2765, J2785, Q9950, Q9951, Q9953, Q9954, Q9955, Q9956, Q9957, Q9965, Q9966, Q9967, Q9982, Q9983.

Additional note has been added to ‘Group 2 Paragraph’ related to PET codes A9597 or A9598.
01/01/2022 R10

Article revised and published on 01/20/2022 effective for dates of service on and after 01/01/2022 to reflect the Annual HCPCS/CPT Code Updates. The following CPT codes have been added to the ‘Credentialing Matrix’ with applicable levels of physician supervision and supervising physician and technician qualification requirements: 0683T, 0685T, 0689T, 0690T, 0694T, 0696T, 0697T, 0698T, 91113, 93319, 93593, 93594, 93595, 93596, 93597 and 93598. The following CPT codes have been deleted and therefore have been removed from the ‘Credentialing Matrix’: 72275, 76101, 76102, 92561, 92564, 93530, 93531, 93532, 93533, 93561, 93562 and 95943.

Additionally, in response to inquiries, the following CPT codes have been added to the ‘Credentialing Matrix’ with applicable levels of physician supervision and supervising physician and technician qualification requirements: 75571 and 92229. The ‘Technician Qualification Requirements’ in the ‘Credentialing Matrix’ has also been revised to add National Healthcareer Association (NHA): Certified EKG Technician (CET) for applicable procedures.
11/11/2021 R9

Article revised and published on 11/11/2021 in response to inquiries to add CPT codes 71271 and 76391 to the ‘Credentialing Matrix’ with applicable levels of physician supervision and supervising physician and technician qualification requirements.
09/09/2021 R8

Article revised and published on 09/09/2021 in response to an inquiry to add CPT codes 0648T and 0649T to the ‘Credentialing Matrix’ with applicable level of physician supervision and supervising physician and technician qualification requirements. Minor formatting changes have also been made.
04/01/2021 R7

Article revised and published on 4.1.2021 effective for dates of service on and after 4.1.2021. The “Interpreting Physician” has been removed from the “Credentialing Matrix” table of supervision as a result of an inquiry.

The following “Physician Supervision of Diagnostic Procedures” #05 was changed to reflect the IOM definition.

The following CPT Codes have had supervisory changes in response to the annual updates: 0554T, 0555T, 0556T, 0557T, 0558T, 71045, 71046, 71047, 71048, 74018, 74019, 74021, 76519, 76706, 76881, 76882, 78264, 78265, 78266, & 93788.
01/01/2021 R6

Article revised and published on 02/11/2021 effective for dates of service on and after 01/01/2021 to reflect the Annual 2021 HCPCS/CPT Code Updates.

CPT codes 92517, 92518, 92519, 92651, 92652, 92653, 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248 and 94619 were added to the “Credentialing Matrix” table section of this billing and coding article.

Also, CPT codes 76970, 78135, 92585, 92586, 94250, 94400, 94750, 94770 and 95071 were deleted from the “Credentialing Matrix” table section of this billing and coding article.

In addition, Descriptors were revised for CPT codes 71250, 71260, 71270, 74425, 76513, 78130, 94617 and 95070.

Minor typographical corrections and formatting changes were made throughout the coding section.
09/24/2020 R5

Revision Number 5
Publication: September 2020 Connection
LCR B2020-014

Explanation of Revision: Based on an inquiry, the “Credentialing Matrix” section of the Billing and Coding article was revised to add CPT codes 10005, 10006, 10007, 10008, 10009, 10010, 10011, 10012, and 10021. The effective date of this revision based on date of service.
07/01/2020 R4

Revision Number: 4
Publication: July 2020 Connection
LCR B2020-011

Explanation of Revision: Based on the July 2020 Quarterly Update, CPT codes 0604T, 0605T, 0606T, 0607T, 0608T, 0609T, 0610T, 0611T, 0612T, and 0615T were added to the “Credentialing Matrix” table section of this billing and coding article. The effective date of this revision is based on date of service.
05/14/2020 R3

Revision Number: 3
Publication: May 2020 Connection
LCR B2020-009

Explanation of Revision: Based on a review, the “Credentialing Matrix” section of the Billing and Coding article was revised to add CPT codes 19081, 19082, 19083, 19084, 19085, and 19086. The effective date of this revision is based on date of service.
01/01/2020 R2

Revision Number: 2
Publication: January 2020 Connection
LCR B2020-002

Explanation of Revision: Explanation of Revision: Based on further review of the Annual 2020 HCPCS Update, HCPCS code G2066 was added. Also, a typographical error was corrected (CPT code 97516 was changed to CPT code 95716). In addition, the “Supervising Physician and Interpreting Physician Qualification Requirements” and “Technician Qualification Requirements” sections of the Credentialing Matrix in the billing and coding article were updated for CPT codes 95700, 95705-95716 and the “Technician Qualification Requirements” section of the Credentialing Matrix was updated for CPT codes 95717-95726. The effective date of this revision is based on date of service.
01/01/2020 R1

Revision Number: 1
Publication: December 2019 Connection
LCR B2020-001

Explanation of Revision: Annual 2020 HCPCS Update. Added CPT codes 74221, 74248, 78429, 78430, 78431, 78432, 78433, 78434, 78830, 78831, 78832, 78835, 92549, 93985, 93986, 95700, 95705, 95706, 95707, 95708, 95709, 95710, 95711, 95712, 95713, 95714, 95715, 95716, 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725 and 95726. In addition, deleted CPT codes 74241, 74245, 74247, 74249, 74260, 78205, 78206, 78320, 78607, 78647, 78710, 78805, 78806, 78807, 93299, 95827, 95950, 95951, 95953 and 95956. Also, the Diagnostic Supervision Indicator for CPT code 78459 changed from “9” to “1”. The effective date of this revision is based on date of service.
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
04/19/2024 04/25/2024 - N/A Currently in Effect View
03/27/2024 04/04/2024 - 04/24/2024 Superseded View
01/19/2024 01/01/2024 - 04/03/2024 Superseded View
09/29/2023 10/01/2023 - 12/31/2023 Superseded You are here
07/14/2023 07/20/2023 - 09/30/2023 Superseded View
01/20/2023 01/01/2023 - 07/19/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A

Read the Article Disclaimer

Submit Feedback/Ask a Question