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SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Independent Diagnostic Testing Facility (IDTF)

A57807

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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.
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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

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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

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Coding Information

Bill Type Codes

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Revenue Codes

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

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Group 1

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ICD-10-CM Codes that Support Medical Necessity

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Group 1

(1 Code)
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Code Description
XX000 Not Applicable
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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(1 Code)
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Code Description
XX000 Not Applicable
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ICD-10-PCS Codes

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Additional ICD-10 Information

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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

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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.

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 Group 1 Codes

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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
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
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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.
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Medicare BPM Ch 15.50.2
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