DRAFT FIRST COAST SERVICE OPTIONS
LOCAL COVERAGE DETERMINATION CODING GUIDELINES
LCD Number
IDTF
Contractor Name
First Coast Service Options, Inc.
Contractor Number
09102 – Florida 09202 – Puerto Rico 09302 – Virgin Islands
LCD Title
Independent Diagnostic Testing Facility (IDTF)
Coding Guidelines
Desk and Site Reviews All new IDTF applications shall receive (1) a thorough desk review, and (2) a mandatory site review prior to the carrier’s enrollment of the applicant and issuance of a billing number. The general purpose of both reviews is to determine whether the information listed on Attachment 2 of the CMS-855B is correct, verifiable, and in accordance with IDTF regulatory and manual requirements. Site Visits for Mobile Units and Electronic Monitoring Services Mobile units are required to list their geographic service area. They can be site visited by the following methods: 1) The mobile unit may visit the office of the site reviewer, or 2) The site reviewer can obtain an advance schedule of the locations the IDTF will be visiting and conduct the site visit at one of those locations. Transtelephonic and electronic monitoring services (e.g., 24-hour ambulatory EKG monitoring; pacemaker monitoring and cardiac event detection) should be classified as IDTFs and must meet all IDTF requirements. These entities require a supervisory physician who performs general supervision. Final enrollment of a transtelephonic or electronic monitoring service as an IDTF requires a site visit. Interpreting Physicians An Independent Diagnostic Testing Facility (IDTF) is not restricted to billing only the technical component of diagnostic services. In certain situations, an IDTF can bill for both the technical component of the diagnostic test and interpretative services. This approach is referred to as billing “globally”. The interpretative services must be performed by a licensed practitioner who is allowed to perform the service. If the interpreting practitioner is an employee of the IDTF, the IDTF must submit a Reassignment of Benefits, Form CMS-855R, which has been signed by the practitioner, in accordance with the Medicare Program Integrity Manual (PIM) Chapter 10, sections 4.19 and 7. If the interpreting practitioner is a contractor performing the interpretation on the premises that the IDTF owns or leases, the IDTF must submit a Reassignment of Benefits, Form CMS-855R, which has been signed by the practitioner, in accordance with PIM Chapter 10, sections 41.19 and 7. In no instance may a group of physicians reassign its benefits to the IDTF. Only individual practitioners may reassign their benefits. When enrolling or updating information, the IDTF shall list all physicians for whose diagnostic test interpretations it will bill. This includes physicians who are providing purchased interpretations to the IDTF (in accordance with CMS Manual System, Pub 100-04, Medicare Claims Processing Manual, Chapter 1, Section 30.2), as well as physicians who are reassigning their benefits to the IDTF. The carrier will ensure and document the following: • All physicians listed are enrolled in Medicare. • All interpreting physicians who are reassigning their benefits to the IDTF have the right to do so. • All required CMS-855R forms have been submitted. • The interpreting physicians listed are qualified to interpret the types of tests (codes) listed. [In accordance with this CMS
requirement (CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 10, Section 4.19.3),
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FCSO Medicare requires that the interpreting physician for a test billed by the IDTF meet the same qualification requirements as the supervising physician for that IDTF test as listed in the ‘Credentialing Matrix’.]
Note: The applicant cannot bill globally for interpreting physicians not listed. If an interpreting physician has been recently added or changed, the new interpreting physician must have met all of the interpreting physician requirements at the time any tests were performed. Off-Site Interpretations If an IDTF wants to bill for an interpretation performed by an independent practitioner off the premises of the IDTF, it must meet all instructions identified in the CMS Manual System, Pub 100-4, Medical Claims Processing Manual, Chapter 1, concerning purchased interpretations. In this scenario, there is no reassignment of benefits because the purchaser of the test is also considered the supplier of the test. When the technical component of a test is performed by the IDTF and the interpreting practitioner is the practitioner who ordered the test, the IDTF cannot bill for the interpretation. The interpreting practitioner must bill the interpretation since the IDTF cannot bill the interpretation when the interpreting physician is the referring physician. Purchased Diagnostic Tests and Jurisdictional Pricing Services that are reimbursed under the Medicare Physician Fee Schedule (MPFS) are reimbursed by the payment locality where the service is furnished and by the zip code. Effective for claims received on or after April 1, 2004, carriers must use the zip code of the location where the service was rendered to determine carrier jurisdiction over the claim and the correct payment locality. When a physician, practitioner, or supplier furnishes services in payment localities that cover more than one carrier’s service area (e.g., the provider has separate offices in multiple localities and/or multiple carriers), separate claims must be submitted to the appropriate carrier for processing. Effective April 1, 2004, providers may not submit a global billing code on paper or electronic claims when one component of the service has been purchased. Only one service facility location (name, address and zip code) can be indicated in item 32 on the CMS-1500 form. Claims received with global services will be returned as unprocessable. Effective January 25, 2005, suppliers (including laboratories, physicians and independent diagnostic testing facilities [IDTFs]) must bill their local carrier for all purchased diagnostic tests/interpretations, regardless of the location where the purchased service was rendered. Purchased Technical Components A physician may bill for the technical component of a diagnostic test that he/she purchased from another physician, medical group or supplier. However, in order to purchase a diagnostic test from another physician, medical group, or supplier, the purchaser must perform the interpretation (professional component). Additionally, the physician or supplier that furnished the technical component must be enrolled in the Medicare program. Purchased Interpretations A person or entity that provides diagnostic tests may submit the claim, and (if assignment is accepted) receive the Part B payment, for diagnostic test interpretations which that person or entity purchases from an independent physician or medical group if: • The tests are initiated by a physician or medical group which is independent of the person or entity providing the tests and of
the physician or medical group providing the interpretations; • The physician or medical group providing the interpretations does not see the patient; and • The purchaser (or employee, partner, or owner of the purchaser) performs the technical component of the test. The
interpreting physician must be enrolled in the Medicare program. No formal reassignment is necessary. • The purchaser must keep on file the name, the provider identification number and address of the interpreting physician. Note: This does not remove the requirement that when an entity either purchases an interpretation or a test, they must perform the other component in order to be paid for the purchased component. In order to price claims correctly and apply purchase price limitations, global billing is not acceptable for claims received on the Form CMS-1500 or on the ANSI X12N 837 electronic format. Each component must be billed as a separate line item (or on a separate claim). Effective for claims with dates of service on or after January 25, 2005, suppliers (including laboratories, physicians, and IDTFs) must submit claims for all purchased diagnostic tests/interpretations to their local carrier, regardless of the location where the purchased service was furnished.
Credentialing Matrix
CPT/HCPCS CODES
LEVEL OF [PHYSICIAN] SUPERVISION
SUPERVISING PHYSICIAN [AND INTERPRETING PHYSICIAN] QUALIFICATION/PROFICIENCY REQUIREMENTS
TECHNICIAN QUALIFICATION REQUIREMENTS
51725 2 Board Certified by the American Board of Medical Specialties (ABMS) Urologist Urology or OB/GYN Personally Trained Staff
51726 2 Board Certified (ABMS) Urologist Urology or OB/GYN Personally Trained Staff
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51736 2 Board Certified (ABMS) Urologist Urology or OB/GYN Personally Trained Staff
51741 2 Board Certified (ABMS) Urologist Urology or OB/GYN Personally Trained Staff
51772 2 Board Certified (ABMS) Urologist Urology or OB/GYN Personally Trained Staff
51784 2 Board Certified (ABMS) Urologist Urology or OB/GYN Personally Trained Staff
51785 3 Board Certified (ABMS) Urologist Urology or OB/GYN Personally Trained Staff
51792 2 Board Certified (ABMS) Urologist Urology or OB/GYN Personally Trained Staff
51795 2 Board Certified (ABMS) Urologist Urology or OB/GYN Personally Trained Staff
51797 2 Board Certified (ABMS) Urologist Urology or OB/GYN Personally Trained Staff
54240 2 Board Certified (ABMS) Urologist Credentialed by ARDMS: RVT or CCI: RVS
54250 1 Board Certified (ABMS) Urologist Credentialed by ARDMS: RVT or CCI: RVS
59025 1 Board Certified (ABMS) Obstetrics/Gynecology Registered Nurse (RN)
70010 3 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70015 3 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70030 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70100 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70110 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70120 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70130 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
70134 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70140 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70150 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70160 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70170 3 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70190 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70200 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70210 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70220 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70240 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70250 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70260 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70300 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
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70310 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70320 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70328 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70330 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70332 3 Board Certified (ABMS) Radiologist State License: General Radiographer
70336 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
70350 1 Board Certified (ABMS) Radiologist State License: General Radiographer70355 1 Board Certified (ABMS) Radiologist State License: General Radiographer
70360 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70370 3 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70371 3 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70373 3 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70380 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
70390 3 Board Certified (ABMS) Radiologist State License: General Radiographer
70450 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70460 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70470 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70480 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70481 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70482 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70486 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70487 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70488 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70490 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70491 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70492 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
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70496 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70498 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
70540 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
70542 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
70543 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
70544 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
70545 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
70546 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
70547 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
70548 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
70549 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
70551 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
70552 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
70553 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
71010 1 Board Certified (ABMS) Radiologist State License: General Radiographer71015 1 Board Certified (ABMS) Radiologist State License: General Radiographer71020 1 Board Certified (ABMS) Radiologist State License: General Radiographer71021 1 Board Certified (ABMS) Radiologist State License: General Radiographer71022 1 Board Certified (ABMS) Radiologist State License: General Radiographer71023 3 Board Certified (ABMS) Radiologist State License: General Radiographer71030 1 Board Certified (ABMS) Radiologist State License: General Radiographer71034 3 Board Certified (ABMS) Radiologist State License: General Radiographer71035 1 Board Certified (ABMS) Radiologist State License: General Radiographer71040 3 Board Certified (ABMS) Radiologist State License: General Radiographer71060 3 Board Certified (ABMS) Radiologist State License: General Radiographer71100 1 Board Certified (ABMS) Radiologist State License: General Radiographer71101 1 Board Certified (ABMS) Radiologist State License: General Radiographer71110 1 Board Certified (ABMS) Radiologist State License: General Radiographer71111 1 Board Certified (ABMS) Radiologist State License: General Radiographer71120 1 Board Certified (ABMS) Radiologist State License: General Radiographer71130 1 Board Certified (ABMS) Radiologist State License: General Radiographer
State License: General Radiographer or
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71250 1 Board Certified (ABMS) Radiologist Medical Physicist and ARRT: R.T.-CT
71260 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
71270 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
71275 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
71550 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
71551 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
71552 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
71555 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72010 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72020 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72040 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72050 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72052 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72069 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72070 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72072 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72074 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72080 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72090 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72100 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72110 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72114 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72120 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72125 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
72126 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
72127 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
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72128 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
72129 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
72130 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
72131 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
72132 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
72133 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
72141 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72142 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72146 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72147 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72148 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72149 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72156 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72157 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72158 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72159 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72170 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72190 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72191 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
72192 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
72193 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
Credentialed by ARRT: MR or ARMRIT:
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72194 2 Board Certified (ABMS) Radiologist MRI
72195 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72196 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72197 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72198 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
72200 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72202 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72220 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72240 3 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72255 3 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72265 3 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72270 3 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72275 3 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist
72285 3 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
72295 3 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
73000 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73010 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73020 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73030 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73040 3 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73050 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73060 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73070 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73080 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73085 3 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73090 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73092 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73100 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
Board Certified (ABMS) Radiologist or State License: General Radiographer or
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73110 1 Orthopaedic Surgeon Medical Physicist
73115 3 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73120 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73130 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73140 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73200 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
73201 2 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
73202 2 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
73206 2 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
73218 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
Credentialed by ARRT: MR or ARMRIT: MRI
73219 2 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
Credentialed by ARRT: MR or ARMRIT: MRI
73220 2 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
Credentialed by ARRT: MR or ARMRIT: MRI
73221 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
Credentialed by ARRT: MR or ARMRIT: MRI
73222 2 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
Credentialed by ARRT: MR or ARMRIT: MRI
73223 2 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
Credentialed by ARRT: MR or ARMRIT: MRI
73225 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
73500 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73510 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73520 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73525 3 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73530 3 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73540 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73542 3 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73550 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73560 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
73562 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
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73564 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
73565 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
73580 3 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
73590 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
73592 1 Board Certified (ABMS) Radiologist or Orthopaedic Surgeon
State License: General Radiographer or Medical Physicist
73600 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
73610 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
73615 3 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
73620 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
73630 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
73650 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
73660 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist
73700 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
73701 2 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
73702 2 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
73706 2 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
73718 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
Credentialed by ARRT: MR or ARMRIT: MRI
73719 2 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
Credentialed by ARRT: MR or ARMRIT: MRI
73720 2 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
Credentialed by ARRT: MR or ARMRIT: MRI
73721 1 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
Credentialed by ARRT: MR or ARMRIT: MRI
73722 2 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
Credentialed by ARRT: MR or ARMRIT: MRI
73723 2 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
Credentialed by ARRT: MR or ARMRIT: MRI
73725 2 Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist
Credentialed by ARRT: MR or ARMRIT: MRI
74000 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
74010 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
Page 10 of 35Coding Guidelines IDTF Independent Diagnostic Testing Facility
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74020 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
74022 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
74150 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
74160 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
74170 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
74175 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
74181 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
74182 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
74183 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
74185 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
74190 3 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
74210 3 Board Certified (ABMS) Radiologist State License: General Radiographer74220 3 Board Certified (ABMS) Radiologist State License: General Radiographer74230 3 Board Certified (ABMS) Radiologist State License: General Radiographer74240 3 Board Certified (ABMS) Radiologist State License: General Radiographer74241 3 Board Certified (ABMS) Radiologist State License: General Radiographer74245 3 Board Certified (ABMS) Radiologist State License: General Radiographer74246 3 Board Certified (ABMS) Radiologist State License: General Radiographer74247 3 Board Certified (ABMS) Radiologist State License: General Radiographer74249 3 Board Certified (ABMS) Radiologist State License: General Radiographer74250 2 Board Certified (ABMS) Radiologist State License: General Radiographer74251 3 Board Certified (ABMS) Radiologist State License: General Radiographer74260 3 Board Certified (ABMS) Radiologist State License: General Radiographer74270 3 Board Certified (ABMS) Radiologist State License: General Radiographer74280 3 Board Certified (ABMS) Radiologist State License: General Radiographer74283 3 Board Certified (ABMS) Radiologist State License: General Radiographer74290 1 Board Certified (ABMS) Radiologist State License: General Radiographer74291 1 Board Certified (ABMS) Radiologist State License: General Radiographer74300 3 Board Certified (ABMS) Radiologist State License: General Radiographer74301 3 Board Certified (ABMS) Radiologist State License: General Radiographer74305 3 Board Certified (ABMS) Radiologist State License: General Radiographer74320 3 Board Certified (ABMS) Radiologist State License: General Radiographer74327 3 Board Certified (ABMS) Radiologist State License: General Radiographer74328 3 Board Certified (ABMS) Radiologist State License: General Radiographer74329 3 Board Certified (ABMS) Radiologist State License: General Radiographer74330 3 Board Certified (ABMS) Radiologist State License: General Radiographer
74400 2 Board Certified (ABMS) Radiologist or Urologist State License: General RadiographerBoard Certified (ABMS) Radiologist or
Page 11 of 35Coding Guidelines IDTF Independent Diagnostic Testing Facility
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74410 2 Urologist State License: General Radiographer
74415 2 Board Certified (ABMS) Radiologist or Urologist State License: General Radiographer
74420 3 Board Certified (ABMS) Radiologist or Urologist State License: General Radiographer
74425 3 Board Certified (ABMS) Radiologist or Urologist State License: General Radiographer
74430 3 Board Certified (ABMS) Radiologist or Urologist State License: General Radiographer
74440 3 Board Certified (ABMS) Radiologist or Urologist State License: General Radiographer
74445 3 Board Certified (ABMS) Radiologist or Urologist State License: General Radiographer
74450 3 Board Certified (ABMS) Radiologist or Urologist State License: General Radiographer
74455 3 Board Certified (ABMS) Radiologist or Urologist State License: General Radiographer
74470 3 Board Certified (ABMS) Radiologist or Urologist State License: General Radiographer
74710 1 Board Certified (ABMS) Radiologist or Urologist
State License: General Radiographer or Medical Physicist
74740 3 Board Certified (ABMS) Radiologist or Gynocologist
State License: General Radiographer or Medical Physicist
74742 3 Board Certified (ABMS) Radiologist or Gynocologist
State License: General Radiographer or Medical Physicist
74775 3 Board Certified (ABMS) Radiologist or Gynocologist State License: General Radiographer
75557 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
75559 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
75561 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
75563 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
75600 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75605 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75625 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75630 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75635 2 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
75650 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75658 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75660 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75662 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75665 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
Page 12 of 35Coding Guidelines IDTF Independent Diagnostic Testing Facility
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75671 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75676 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75680 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75685 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75705 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75710 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75716 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75722 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75724 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75726 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75731 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75733 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75736 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75741 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75743 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75746 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75756 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75774 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75790 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75801 3 Board Certified (ABMS) Radiologist State License: General Radiographer75803 3 Board Certified (ABMS) Radiologist State License: General Radiographer75805 3 Board Certified (ABMS) Radiologist State License: General Radiographer75807 3 Board Certified (ABMS) Radiologist State License: General Radiographer75809 3 Board Certified (ABMS) Radiologist State License: General Radiographer
75810 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75820 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75822 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75825 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75827 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75831 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75833 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75840 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
Page 13 of 35Coding Guidelines IDTF Independent Diagnostic Testing Facility
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75842 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75860 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75870 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75872 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75880 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75885 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75887 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75889 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
75891 3 Board Certified (ABMS) Radiologist [or Vascular Surgeon] State License: General Radiographer
76000 3 Board Certified (ABMS) Radiologist or in the field related to the Primary Procedure State License: General Radiographer
76001 3 Board Certified (ABMS) Radiologist or in the field related to the Primary Procedure State License: General Radiographer
76010 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
76080 3 Board Certified (ABMS) Radiologist State License: General Radiographer76098 1 Board Certified (ABMS) Radiologist State License: General Radiographer76100 1 Board Certified (ABMS) Radiologist State License: General Radiographer76101 2 Board Certified (ABMS) Radiologist State License: General Radiographer76102 2 Board Certified (ABMS) Radiologist State License: General Radiographer76120 2 Board Certified (ABMS) Radiologist State License: General Radiographer76125 2 Board Certified (ABMS) Radiologist State License: General Radiographer76150 1 Board Certified (ABMS) Radiologist State License: General Radiographer76350 2 Board Certified (ABMS) Radiologist State License: General Radiographer
76376 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
76377 3 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
76380 1 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
76390 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
76506 1 Board Certified (ABMS) Radiologist or Neurologist
Credentialed by ARDMS: RDMS-NE or ARRT:R.T.-S
76510 2 Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist
Credentialed by ARDMS: RDMS-OP or JCAHPO: COT or COMT
76511 2 Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist
Credentialed by ARDMS: RDMS-OP or JCAHPO: COT or COMT
76512 2 Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist
Credentialed by ARDMS: RDMS-OP or JCAHPO: COT or COMT
76513 2 Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist
Credentialed by ARDMS: RDMS-OP or JCAHPO: COT or COMT
76514 1 Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist
Credentialed by ARDMS: RDMS-OP or JCAHPO: COT or COMT
76516 1 Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist
Credentialed by ARDMS: ROUB or RDMS-OP or JCAHPO: COT or COMT
Board Certified (ABMS) Opthalmologist, Credentialed by ARDMS: ROUB or RDMS-
Page 14 of 35Coding Guidelines IDTF Independent Diagnostic Testing Facility
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76519 1 Radiologist or Optometrist OP or JCAHPO: COT or COMT
76529 1 Board Certified (ABMS) Opthalmologist or Radiologist
Credentialed by ARDMS: ROUB or RDMS-OP or JCAHPO: COT or COMT
76536 1 Board Certified (ABMS) Radiologist or Neurologist
Credentialed by ARDMS: RDMS or ARRT: R.T.-S
76604 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS or ARRT:R.T.-S
76645 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS or ARRT: R.T.-BS
76700 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS RDMS or ARRT: R.T.-S
76705 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS or ARRT: R.T.-S
76770 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS or ARRT: R.T.-S
76775 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS or ARRT: R.T.-S
76776 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS or ARRT: R.T.-S
76800 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-NE or ARRT: R.T.-S
76801 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76802 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76805 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76810 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76811 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76812 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76813 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76814 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76815 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76816 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76817 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76818 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76819 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76820 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76821 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76825 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76826 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76827 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76828 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S Credentialed by ARDMS: RDMS-OB/GYN
Page 15 of 35Coding Guidelines IDTF Independent Diagnostic Testing Facility
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76830 1 Board Certified (ABMS) Radiologist or ARRT: R.T.-S
76831 3 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76856 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76857 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S
76870 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS or ARRT: R.T.-S
76872 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS or ARRT: R.T.-S
76873 2 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS or ARRT: R.T.-S
76880 1 Board Certified (ABMS) Radiologist or Podiatrist
Credentialed by ARDMS: RDMS or ARRT: R.T.-S
76885 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS or ARRT: R.T.-S
76886 1 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS or ARRT: R.T.-S
76942 3 Board Certified (ABMS) Radiologist or Podiatrist
Credentialed by ARDMS: RDMS or ARRT: R.T. - S
76946 3 Board Certified (ABMS) Radiologist Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T. - S
76970 1 Board Certified (ABMS) Radiologist Credendentialed by ARDMS: RDMS or ARRT:R.T.-S
76975 3 Board Certified (ABMS) Radiologist Credendentialed by ARDMS: RDMS or ARRT:R.T.-S
76977 1 Board Certified (ABMS) Radiologist or Podiatrist
Credendentialed by ARDMS: RDMS or ARRT:R.T.-S or- BD
77002 3 Board Certified (ABMS) Radiologist or in the field related to the Primary Procedure State License: General Radiographer
77003 3 Board Certified (ABMS) Radiologist or in the field related to the Primary Procedure State License: General Radiographer
77012 3 Board Certified (ABMS) Radiologist or Podiatrist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
77014 2 Board Certified (ABMS) RadiologistState License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
77021 3 Board Certified (ABMS) Radiologist or Podiatrist
Credentialed by ARRT: MR or ARMRIT: MRI
77031 3 Board Certified (ABMS) Radiologist State License: General Radiographer77032 3 Board Certified (ABMS) Radiologist State License: General Radiographer
77051 1 Board Certified (ABMS) Radiologist
State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography
77052 1 Board Certified (ABMS) Radiologist
State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography
77053 3 Board Certified (ABMS) Radiologist State License: General Radiographer and ARRT: R.T.-M
77054 3 Board Certified (ABMS) Radiologist State License: General Radiographer and ARRT: R.T.-M
77055 1 Board Certified (ABMS) Radiologist
State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography
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77056 1 Board Certified (ABMS) Radiologist
State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography
77057 1 Board Certified (ABMS) Radiologist
State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography
77058 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
77059 2 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
77071 3 Board Certified (ABMS) Radiologist or Podiatrist
Physician Service Code - Must be performed by a physician
77072 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
77073 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
77074 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
77075 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
77076 1 Board Certified (ABMS) Radiologist State License: General Radiographer or Medical Physicist
77077 1 Board Certified (ABMS) Radiologist or Podiatrist
State License: General Radiographer or Medical Physicist
77078 1 Board Certified (ABMS) RadiologistState License: General Radiographer and ARRT: R.T.-CT
77079 1 Board Certified (ABMS) RadiologistState License: General Radiographer and ARRT: R.T.-CT
77080 1 Board Certified (ABMS) Radiologist or Internal Medicine Specialist
State License: General Radiographer and ARRT: R.T.-BD
77081 1 Board Certified (ABMS) Radiologist or Internal Medicine Specialist
State License: General Radiographer and ARRT: R.T.-BD
77082 1 Board Certified (ABMS) Radiologist or Internal Medicine Specialist
State License: General Radiographer and ARRT: R.T.-BD
77083 1 Board Certified (ABMS) Radiologist or Internal Medicine Specialist
State License: General Radiographer and ARRT: R.T.-BD
77084 1 Board Certified (ABMS) RadiologistCredentialed by ARRT: MR or ARMRIT: MRI
77417 1 Board Certified (ABMS) Radiologist State License: General Radiographer or medical physicist
78000 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78001 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78003 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78006 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78007 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78010 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78011 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78015 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
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78016 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78018 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78020 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78070 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78075 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78102 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78103 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78104 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78110 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78111 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78120 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78121 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78122 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78130 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78135 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78140 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78185 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78190 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78191 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78195 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78201 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78202 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78205 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78206 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78215 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78216 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78220 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78223 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78230 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78231 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
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78232 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78258 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78261 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78262 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78264 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78267 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78268 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78270 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78271 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78272 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78278 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78282 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78290 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78291 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78300 1 Board Certified (ABMS) Nuclear Medicine, Radiology or Podiatrist ARRT: N or NMTCB: CNMT
78305 1 Board Certified (ABMS) Nuclear Medicine, Radiology or Podiatrist ARRT: N or NMTCB: CNMT
78306 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78315 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78320 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78350 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78414 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78428 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78445 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78456 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78457 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78458 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78459 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78460 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78461 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78464 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
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78465 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78466 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78468 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78469 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78472 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78473 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78478 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78480 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78481 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78483 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78491 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78492 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78494 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78496 1 Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology ARRT: N or NMTCB: CNMT
78580 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78584 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78585 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78586 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78587 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78588 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78591 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78593 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78594 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78596 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78600 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78601 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78605 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78606 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78607 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78608 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
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78610 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78630 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78635 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78645 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78647 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78650 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78660 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78700 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78701 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78707 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78708 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78709 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78710 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78725 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78730 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78740 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78761 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78800 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78801 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78802 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78803 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78804 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78805 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78806 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78807 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78811 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78812 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78813 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78814 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
78815 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
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78816 1 Board Certified (ABMS) Nuclear Medicine or Radiology ARRT: N or NMTCB: CNMT
91000 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91010 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91011 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91012 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91020 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91022 2 Board certified (ABMS) Gastroenterologist Registered Nurse (RN)
91030 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91034 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91035 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91037 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91038 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91040 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91052 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91055 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91065 2 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91120 2 Board Certified (ABMS) Gastroenterologist Colorectal Surgeon Registered Nurse (RN)
91122 2 Board Certified (ABMS) Gastroenterologist Colorectal Surgeon Registered Nurse (RN)
91132 3 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
91133 3 Board Certified (ABMS) Gastroenterologist Registered Nurse (RN)
92060 1 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92081 1 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92082 1 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92083 1 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92100 9
Board Certified (ABMS) Ophthalmologist or Optometrist/Physician Supervision concept does not apply
Physician Service Code - Must be performed by a physician
92120 9
Board Certified (ABMS) Ophthalmologist or Optometrist/Physician Supervision concept does not apply
Physician Service Code - Must be performed by a physician
92130 9
Board Certified (ABMS) Ophthalmologist or Optometrist/Physician Supervision concept does not apply
Physician Service Code - Must be performed by a physician
92135 1 Board Certified (ABMS) Ophthalmologist or Optometrist Credendentialed by JCAHPO: COT or COMT
92136 1 Board Certified (ABMS) Ophthalmologist or Optometrist Credentialed by JCAHPO: COT or COMTBoard Certified (ABMS) Ophthalmologist,
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92235 2 Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92240 2 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92250 1 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92265 3 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92270 1 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92275 1 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92283 1 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92284 1 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92285 1 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist Credentialed by JCAHPO: COT or COMT
92286 1 Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist
Credentialed by JCAHPO: COT or COMT or OPS: CRA
92541 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92542 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92543 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92544 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92545 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92546 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92547 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92548 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92552 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92553 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92555 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92556 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92557 5 Board Certified (ABMS) Neurologist or Otolaryngologist
Physician Service Code – must be performed by a physician
92561 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92562 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92563 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92564 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92565 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92567 5 Board Certified (ABMS) Neurologist or Otolaryngologist
Physician Service Code – must be performed by a physician
92568 5 Board Certified (ABMS) Neurologist or Otolaryngologist
Physician Service Code – must be performed by a physician
Board Certified (ABMS) Neurologist or Physician Service Code – must be performed
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92569 5 Otolaryngologist by a physician
92571 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92572 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92575 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92576 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92577 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92579 5 Board Certified (ABMS) Neurologist or Otolaryngologist
Physician Service Code – must be performed by a physician
92582 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92583 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92584 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92585 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92586 9
Board Certified (ABMS) Neurologist or Otolaryngologist/Concept of physician supervision does not apply Licensed Audiologist
92587 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92588 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92596 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92597 9 Board Certified (ABMS) Neurologist or Otolaryngologist
Physician service code - must be performed by a physician
92601 5 Board Certified (ABMS) Neurologist or Otolaryngologist
Physician Service Code - must be performed by a physician
92602 5 Board Certified (ABMS) Neurologist or Otolaryngologist
Physician Service Code - must be performed by a physician
92603 5 Board Certified (ABMS) Neurologist or Otolaryngologist
Physician Service Code - must be performed by a physician
92604 5 Board Certified (ABMS) Neurologist or Otolaryngologist
Physician Service Code - must be performed by a physician
92620 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92621 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
92625 5 Board Certified (ABMS) Neurologist or Otolaryngologist Licensed Audiologist
93000 1 Board Certified (ABMS) Internist or Cardiologist
RN, LPN, or State licensed Paramedic or credentialed by CCI: CCT
93005 1 Board Certified (ABMS) Internist or Cardiologist
RN, LPN, or State licensed Paramedic or credentialed by CCI: CCT
93010 9
Board Certified (ABMS) Internist or Cardiologist/Concept of physician supervision does not apply
Professional component only code - must be performed by a physician
93012 1 Board Certified (ABMS) Internist or Cardiologist
RN, State licensed Paramedic or credentialed by CCI: CCT
93014 9
Board Certified (ABMS) Internist or Cardiologist/Concept of physician supervision does not apply
Professional component only code - must be performed by a physician
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93015 2 Board Certified (ABMS) Internist or Cardiologist - ACLS certified
RN, State licensed Paramedic or credentialed by CCI: CCT
93016 2 Board Certified (ABMS) Internist or Cardiologist - ACLS certified
RN, State licensed Paramedic or credentialed by CCI: CCT
93017 2 Board Certified (ABMS) Internist or Cardiologist - ACLS certified
RN, State licensed Paramedic or credentialed by CCI: CCT
93018 9 Board Certified (ABMS) Cardiologist/ Physician Supervision concept does not apply
Professional component only code - must be performed by a physician
93024 3 Board Certified (ABMS) Internist or Cardiologist - ACLS certified
RN, State licensed Paramedic or credentialed by CCI: CCT
93025 2 Board Certified (ABMS) Internist or Cardiologist - ACLS certified
RN, State licensed Paramedic or credentialed by CCI: CCT
93040 1 Board Certified (ABMS) Internist or Cardiologist
RN, State licensed Paramedic or credentialed by CCI: CCT
93041 1 Board Certified (ABMS) Internist or Cardiologist
RN, State licensed Paramedic or credentialed by CCI: CCT
93042 9 Board Certified (ABMS) Cardiologist/ Physician Supervision concept does not apply
Professional component code - must be performed by a physician
93224 1 Board Certified (ABMS) CardiologistRN, State licensed Paramedic or credentialed by CCI: CCT
93225 1 Board Certified (ABMS) CardiologistRN, State licensed Paramedic or credentialed by CCI: CCT
93226 1 Board Certified (ABMS) CardiologistRN, State licensed Paramedic or credentialed by CCI: CCT
93227 9 Board Certified (ABMS) Cardiologist/ Physician Supervision concept does not apply
Professional component only code - must be performed by a physician
93228 0 Board Certified (ABMS) CardiologistProfessional component only code – service must be performed by a physician
93229 1 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic or credentialed by CCI: CCT
93230 1 Board Certified (ABMS) CardiologistRN, State licensed Paramedic or credentialed by CCI: CCT
93231 1 Board Certified (ABMS) CardiologistRN, State licensed Paramedic or credentialed by CCI: CCT
93232 1 Board Certified (ABMS) CardiologistRN, State licensed Paramedic or credentialed by CCI: CCT
93233 9 Board Certified (ABMS) Cardiologist/ Physician Supervision concept does not apply
Professional component only code - must be performed by a physician
93235 1 Board Certified (ABMS) CardiologistRN, State licensed Paramedic or credentialed by CCI: CCT
93236 1 Board Certified (ABMS) CardiologistRN, State licensed Paramedic or credentialed by CCI: CCT
93237 9 Board Certified (ABMS) Cardiologist/ Physician Supervision concept does not apply
Professional component only code - must be performed by a physician
93268 1 Board Certified (ABMS) CardiologistRN, State licensed Paramedic or credentialed by CCI: CCT
RN, State licensed Paramedic or credentialed
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93270 1 Board Certified (ABMS) Cardiologist by CCI: CCT
93271 1 Board Certified (ABMS) CardiologistRN, State licensed Paramedic or credentialed by CCI: CCT
93272 9 Board Certified (ABMS) Cardiologist/ Physician Supervision concept does not apply
Professional component only code - must be performed by a physician
93278 1 Board Certified (ABMS) CardiologistRN, State licensed Paramedic or credentialed by CCI: CCT
93279 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93280 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93281 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93282 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93283 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93284 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93285 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93286 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93287 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93288 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93289 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93290 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93291 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93292 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93293 2 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93294 2 Board Certified (ABMS) CardiologistProfessional component only code – service must be performed by a physician
93295 0 Board Certified (ABMS) CardiologistProfessional component only code – service must be performed by a physician
93296 1 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93297 2 Board Certified (ABMS) CardiologistProfessional component only code – service must be performed by a physician
93298 2 Board Certified (ABMS) CardiologistProfessional component only code – service must be performed by a physician
93299 1 Board Certified (ABMS) CardiologistState Licensed: RN or Paramedic, or credentialed by CCI: CCT
93303 1 Board Certified (ABMS) Cardiologist Credentialed by ARDMS: RDCS or CCI: RCS
93304 1 Board Certified (ABMS) Cardiologist Credentialed by ARDMS: RDCS or CCI: RCS
93306 1 Board Certified (ABMS) Cardiologist Credentialed by ARDMS: RDCS or CCI: RCS
93307 1 Board Certified (ABMS) Cardiologist Credentialed by ARDMS: RDCS or CCI: RCS
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93308 1 Board Certified (ABMS) Cardiologist Credentialed by ARDMS: RDCS or CCI: RCS
93312 3 Board Certified (ABMS) Cardiologist Credentialed by ARDMS: RDCS or CCI: RCS
93313 3 Board Certified (ABMS) CardiologistPhysician Service Code - must be performed by a physician
93314 3 Board Certified (ABMS) Cardiologist Credentialed by ARDMS: RDCS or CCI: RCS
93315 3 Board Certified (ABMS) Cardiologist Credentialed by ARDMS: RDCS or CCI: RCS
93316 3 Board Certified (ABMS) CardiologistPhysician Service Code - must be performed by a physician
93317 3 Board Certified (ABMS) Cardiologist Credentialed by ARDMS: RDCS or CCI: RCS
93320 1 Board Certified (ABMS) Cardiologist Credentialed by ARDMS: RDCS or CCI: RCS
93321 1 Board Certified (ABMS) Cardiologist Credentialed by ARDMS: RDCS or CCI: RCS
93325 1 Board Certified (ABMS) Cardiologist Credentialed by ARDMS: RDCS or CCI: RCS
93350 2 Board Certified (ABMS) CardiologistCredentialed by ARDMS: RDCS or CCI: RCS, RN or State licensed Paramedic
93351 2 Board Certified (ABMS) CardiologistState Licensed RN or Paramedic, or Credentialed by ARDMS: RDCS or CCI: RCS
93352 9 Board Certified (ABMS) CardiologistPhysician service code – service must be performed by a physician
[93501 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93508 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93510 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93511 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93526 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93527 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93529 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93530 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93531 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93532 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93533 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by
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93555 3 the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93556 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93561 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93562 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93571 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS
93572 3
Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3 Credentialed by: ARRT: CI or CCI: RCIS]
93660 1 Board Certified (ABMS) CardiologistCredentialed by CCI: CCT, RCIS, RCS or ARDMS: RDCS or RN
93701 1 Board Certified (ABMS) Cardiologist Demonstrates Proficiency
93720 1 Board Certified (ABMS) Pulmonologist Credentialed by ARDMS: RVT or CCI: RVS93721 1 Board Certified (ABMS) Pulmonologist Certified by ARDMS: RVT, CCI: RVS
93740 1 Board Certified (ABMS) CardiologistCredentialed by CCI: CCT, State licensed Paramedic or RN
93770 1 Board Certified (ABMS) CardiologistCredentialed by CCI: CCT, State licensed Paramedic or RN
93784 1 Board Certified (ABMS) Cardiologist, Internal Medicine or Family Practice
Credentialed by CCI: CCT, State licensed Paramedic or RN
93786 1 Board Certified (ABMS) Cardiologist, Internal Medicine or Family Practice
Credentialed by CCI: CCT, State licensed Paramedic or RN
93788 1 Board Certified (ABMS) Cardiologist, Internal Medicine or Family Practice
Credentialed by CCI: CCT, State licensed Paramedic or RN
93790 9
Board Certified (ABMS) Cardiologist, Internal Medicine or Family Practice/ Physician supervision concept does not apply
Professional component only code - must be performed by a physician
93875 1
Board Certified (ABMS) Radiologist, Neurologist[,] or Cardiologist [or Vascular Surgeon] - refer to FCSO LCD 93875 Non-invasive Extracranial Arterial Studies for additional credentialing [training] requirements
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93880 1
Board Certified (ABMS) Radiologist, Neurologist[,] or Cardiologist [or Vascular Surgeon] - refer to FCSO LCD 93875 Non-invasive Extracranial Arterial Studies for additional credentialing [training] requirements
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93882 1
Board Certified (ABMS) Radiologist, Neurologist[,] or Cardiologist [or Vascular Surgeon] - refer to FCSO LCD 93875 Non-invasive Extracranial Arterial Studies for additional credentialing [training] requirements
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93886 1
Board Certified (ABMS) Radiologist, Neurologist[,] or Cardiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93888 1
Board Certified (ABMS) Radiologist, Neurologist[,] or Cardiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
Board Certified (ABMS) Radiologist,
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93890 1 Neurologist[,] or Cardiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93892 1
Board Certified (ABMS) Radiologist, Neurologist[,] or Cardiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93893 1
Board Certified (ABMS) Radiologist, Neurologist[,] or Cardiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93922 1
Board Certified (ABMS) Radiologist, Cardiologist[,] or Podiatrist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93923 1
Board Certified (ABMS) Radiologist, Cardiologist[,] or Podiatrist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93924 1
Board Certified (ABMS) Radiologist, Cardiologist[,] or Podiatrist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93925 1
Board Certified (ABMS) Radiologist, Cardiologist[,] or Podiatrist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93926 1
Board Certified (ABMS) Radiologist, Cardiologist[,] or Podiatrist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93930 1 Board Certified (ABMS) Radiologist[,] or Cardiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93931 1 Board Certified (ABMS) Radiologist[,] or Cardiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93965 1 Board Certified (ABMS) Radiologist[,] or Cardiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93970 1 Board Certified (ABMS) Radiologist[,] or Cardiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93971 1 Board Certified (ABMS) Radiologist[,] or Cardiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93975 1 Board Certified (ABMS) Radiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93976 1 Board Certified (ABMS) Radiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93978 1 Board Certified (ABMS) Radiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93979 1 Board Certified (ABMS) Radiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93980 1 Board Certified (ABMS) Radiologist[,] or Urologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93981 1 Board Certified (ABMS) Radiologist[,] or Urologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
93990 1 Board Certified (ABMS) Radiologist [or Vascular Surgeon]
Credentialed by ARDMS: RVT, ARRT: VS or CCI: RVS
94010 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist or RN
94014 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist or RN
94015 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist or RN
94016 9 Board Certified (ABMS) Pulmonologist/ Physician supervision concept does not apply
Professional component only code - must be performed by a physician
94060 2 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist or RN
94070 2 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist or RN 94150 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist
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94200 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94240 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94250 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94260 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94350 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94360 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94370 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94375 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94400 2 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94450 2 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist
94452 2 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist or RN
94453 2 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist or RN
94620 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist or RN
94621 2 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist or RN
94664 2 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist or RN 94680 2 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94681 2 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94690 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94720 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94725 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94750 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94760 1 Board Certified (ABMS) Pulmonologist Demonstrates proficiency 94761 1 Board Certified (ABMS) Pulmonologist Demonstrates proficiency 94762 1 Board Certified (ABMS) Pulmonologist Demonstrates proficiency 94770 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 94772 1 Board Certified (ABMS) Pulmonologist State License: Respiratory Therapist 95028 2 Board Certified (ABMS) Otolaryngologist Registered Nurse (RN) 95044 2 Board Certified (ABMS) Otolaryngologist Registered Nurse (RN) 95052 2 Board Certified (ABMS) Otolaryngologist Registered Nurse (RN) 95056 2 Board Certified (ABMS) Otolaryngologist Registered Nurse (RN)
95060 3 Board Certified (ABMS) Otolaryngologist, Ophthalmologist or Optometrist Registered Nurse (RN)
95065 3 Board Certified (ABMS) Otolaryngologist Registered Nurse (RN) 95070 2 Board Certified (ABMS) Otolaryngologist Registered Nurse (RN) 95071 2 Board Certified (ABMS) Otolaryngologist Registered Nurse (RN)
95805 1
Board Certified (ABMS) Pulmonologist, Neurologist or [Physician] Certified by the American Board of Sleep Medicine (ABSM)[: Sleep Medicine or ABMS: Sleep Medicine]
Credentialed by BRPT: RPSGT[,] or ABRET: R. EEG T. (Polysomnography)[, CRT: SDS or RRT: SDS]
95806 1
Board Certified (ABMS) Pulmonologist, Neurologist or Certified by the American Board of Sleep Medicine (ABSM)
Credentialed by BRPT: RPSGT or ABRET: R. EEG T. (Polysomnography)
95807 1
Board Certified (ABMS) Pulmonologist, Neurologist or [Physician] Certified by the American Board of Sleep Medicine (ABSM) [: Sleep Medicine or ABMS: Sleep Medicine]
Credentialed by BRPT: RPSGT[,] or ABRET: R. EEG T. (Polysomnography)[, CRT: SDS or RRT: SDS]
95808 1
Board Certified (ABMS) Pulmonologist, Neurologist or [Physician] Certified by the American Board of Sleep Medicine (ABSM) [: Sleep Medicine or ABMS: Sleep Medicine]
Credentialed by BRPT: RPSGT[,] or ABRET: R. EEG T. (Polysomnography)[, CRT: SDS or RRT: SDS]
Board Certified (ABMS) Pulmonologist,
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95810 1
Neurologist or [Physician] Certified by the American Board of Sleep Medicine (ABSM) [: Sleep Medicine or ABMS: Sleep Medicine]
Credentialed by BRPT: RPSGT[,] or ABRET: R. EEG T. (Polysomnography)[, CRT: SDS or RRT: SDS]
95811 1
Board Certified (ABMS) Pulmonologist, Neurologist or [Physician] Certified by the American Board of Sleep Medicine (ABSM) [: Sleep Medicine or ABMS: Sleep Medicine]
Credentialed by BRPT: RPSGT[,] or ABRET: R. EEG T. (Polysomnography)[, CRT: SDS or RRT: SDS]
95812 1 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T95813 1 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T95816 1 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T95819 1 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T95822 1 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T95824 1 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T95827 1 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T
95830 9 Board Certified (ABMS) Neurologist/ Physician Supervision concept does not apply
Physician service code - must be performed by a physician
95860 6A Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EP T.95861 6A Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EP T.95863 6A Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EP T.95864 6A Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EP T.95867 6A Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EP T.95868 6A Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EP T.95869 6A Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EP T.95870 6A Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EP T.95872 66 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EP T.95875 3 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EP T.
95900 7A
Board Certified (ABMS) Neurologist or Podiatrist - General supervision level applices if PT not certified
Credentialed by AAET: R. EDT., ABRET: R. EP T. or State Licensed Physical Therapist with ABPTS certification or Qualified Physical Therapist
95903 7A
Board Certified (ABMS) Neurologist or Podiatrist - General supervision level applices if PT not certified
Credentialed by AAET: R. EDT., ABRET: R. EP T. or State Licensed Physical Therapist with ABPTS certification or Qualified Physical Therapist
95904 7A
Board Certified (ABMS) Neurologist or Podiatrist - General supervision level applices if PT not certified
Credentialed by AAET: R. EDT., ABRET: R. EP T. or State Licensed Physical Therapist with ABPTS certification or Qualified Physical Therapist
95921 2 Board Certified (ABMS) Neurologist Credentialed by AAET: R. EDT95922 3 Board Certified (ABMS) Neurologist Credentialed by AAET: R. EDT95923 3 Board Certified (ABMS) Neurologist Credentialed by AAET: R. EDT
95925 21 Board Certified (ABMS) NeurologistCredentialed by ABRET: R. EPT or R. EEG T.
95926 21 Board Certified (ABMS) Neurologist or Podiatrist
Credentialed by ABRET: R. EPT or R. EEG T.
95927 21 Board Certified (ABMS) NeurologistCredentialed by ABRET: R. EPT or R. EEG T.
95928 21 Board Certified (ABMS) NeurologistCredentialed by ABRET: R. EPT or R. EEG T.
95929 21 Board Certified (ABMS) NeurologistCredentialed by ABRET: R. EPT or R. EEG T.
95930 21 Board Certified (ABMS) NeurologistCredentialed by ABRET: R. EPT or R. EEG T.
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95933 7A
Board Certified (ABMS) Neurologist -General supervision level applices if PT not certified
Credentialed by AAET: R. EDT., State licensed Physical Therapist with ABPTS certification or Qualified Physical Therapist
95934 7A
Board Certified (ABMS) Neurologist or Podiatrist - General supervision level applices if PT not certified
Credentialed by AAET: R. EDT., State licensed Physical Therapist with ABPTS certification or Qualified Physical Therapist
95936 7A
Board Certified (ABMS) Neurologist -General supervision level applices if PT not certified
Credentialed by AAET: R. EDT., State licensed Physical Therapist with ABPTS certification or Qualified Physical Therapist
95937 7A
Board Certified (ABMS) Neurologist or Podiatrist - General supervision level applices if PT not certified
Credentialed by AAET: R. EDT., State licensed Physical Therapist with ABPTS certification or Qualified Physical Therapist
95950 1 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T95951 1 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T95953 1 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T95954 3 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T95956 1 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T95957 1 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T95958 3 Board Certified (ABMS) Neurologist Credentialed by ABRET: R. EEG T
96103 4 Psychiatrist, Clinical psychologist or qualified independent psychologist
Physician service code - must be performed by a physician
96105 4 Psychiatrist, Clinical psychologist or qualified independent psychologist
Physician service code - must be performed by a physician
96110 4 Psychiatrist, Clinical psychologist or qualified independent psychologist
Physician service code - must be performed by a physician
96111 4 Psychiatrist, Clinical psychologist or qualified independent psychologist
Physician service code - must be performed by a physician
96119 4 Psychiatrist, Clinical psychologist or qualified independent psychologist
Physician service code - must be performed by a physician
96120 4 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 and Credentialed by ARRT: R.T.-N or NMTCB: CNMT
G0130 1 Board Certified (ABMS) RadiologistState License: General Radiographer and Credentialed by ARRT: R.T.-BD
G0202 1 Board Certified (ABMS) Radiologist
State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography
G0204 1 Board Certified (ABMS) Radiologist
State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography
G0206 1 Board Certified (ABMS) Radiologist
State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography
G0235 1 Board Certified (ABMS) Nuclear Medicine or Radiology
State License: General Radiographer and Credentialed by ARRT: R.T.-N or NMTCB: CNMT
G0248 1 Board Certified (ABMS) Cardiologist Registered Nurse (RN) G0249 1 Board Certified (ABMS) Cardiologist Demonstrates Proficiency
G0389 1 Board Certified (ABMS) RadiologistARDMS: RDMS – Abdomen or ARRT: R.T.-S
Board Certified (ABMS) Physician Certified by the American Board of Sleep Medicine Credentialed by BRPT: RPSGT or ABRET:
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Key for IDTF Table Abbreviations
American Association of Electrodiagnostic Technologists (AAET) http://www.aaet.info/resources/job_descriptions_for_edxtech.cfm Registered Electrodiagnostic Technologist (R. EDT.)
[American Board of Medical Specialties (ABMS) http://www.abms.org/]
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 Registry of Diagnostic Medical Sonographers (ARDMS) |http://www.ardms.org/aboutardms/overview.htm 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
G0398 1 (ABSM) R. EEG T. (Polysomnography)
G0399 1
Board Certified (ABMS) Physician Certified by the American Board of Sleep Medicine (ABSM)
Credentialed by BRPT: RPSGT or ABRET: R. EEG T. (Polysomnography)
G0400 1
Board Certified (ABMS) Physician Certified by the American Board of Sleep Medicine (ABSM)
Credentialed by BRPT: RPSGT or ABRET: R. EEG T. (Polysomnography)
Q0035 1 Board Certified (ABMS) CardiologistCredentialed by CCI: CCT, State licensed Paramedic or RN
0067T 1 Board Certified (ABMS) Gastroenterologist or Radiologist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
0145T 1 Board Certified (ABMS) Cardiologist or Radiologist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
0146T 1 Board Certified (ABMS) Cardiologist or Radiologist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
0147T 1 Board Certified (ABMS) Cardiologist or Radiologist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
0148T 1 Board Certified (ABMS) Cardiologist or Radiologist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
0149T 1 Board Certified (ABMS) Cardiologist or Radiologist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
0150T 1 Board Certified (ABMS) Cardiologist or Radiologist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
0151T 1 Board Certified (ABMS) Cardiologist or Radiologist
State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT
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The American Registry of Radiologic Technologists (ARRT) http://www.arrt.org/index.html 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 –Sonograpy (R.T.-S) Certified and Registered Technologist –Vascular Sonography (R.T.-VS)
The Board of Certification of the Ophthalmic Photographers’ Society http://www.opsweb.org/Certif/Certif.html Certified Retinal Angiographer (CRA)
Board of Registered Polysomnographic Technologists (BRPT) http://www.brpt.org/ Registered Polysomnographic Technologist (RPSGT)
Cardiovascular Credentialing International (CCI) http://www.cci-online.org/ Certified Cardiographic Technician (CCT) Registered Cardiac Sonographer (RCS) Registered Cardiovascular Invasive Specialist (RCIS) Registered Vascular Specialist (RVS)
Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO) http://www.jcahpo.org/newsite/certificationhome.htm 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 Disorder Specialist (SDS)] Registered Respiratory Therapist (RRT)[: Sleep Disorder Specialist (SDS)]
Nuclear Medicine Technology Certification Board (NMTCB) http://www.nmtcb.org/ Certified Nuclear Medicine Technologist (CNMT)
Revision History
Date Revision
MM/DD/YYYY 1 – Revisions include: ‘Interpreting Physicians’ section revised to add language to indicate that an interpreting physician for a test billed by the IDTF is required to meet the same qualification requirements as the supervising physician for that test. In this regard, the ‘Credentialing Matrix’ was revised to change the title of column ‘Supervising Physician Qualification/Proficiency Requirements’ to “Supervising Physician and Interpreting Physician Qualification Requirements”. The ‘Credentialing Matrix’ was revised to delete CPT codes 76800 and 95806, as
Page 34 of 35Coding Guidelines IDTF Independent Diagnostic Testing Facility
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Document formatted: 01/27/2008 (JG/st)
these codes have been added to the List of Medicare Noncovered Services LCD and to add the following CPT codes: 93501, 93508, 93510, 93511, 93526, 93527, 93529, 93530, 93531, 93532, 93533, 93555, 93556, 93561, 93562, 93571 and 93572 and the following requirements : Level of Physician Supervision ‘3’, Supervising Physician and Interpreting Physician Qualification Requirements ‘Board Certified (ABMS) Cardiologist with Level 2 Training (minimum) as outlined by the ACC/AHA Task Force 3’ and Technician Qualification Requirements ‘Credentialed by ARRT: CI or CCI: RCIS’: The ‘Supervising Physician and Interpreting Physician Qualification Requirements’ section of ‘Credentialing Matrix’ was revised for CPT codes 95805, 95807, 95808, 95810 and 95811 to read ‘Board Certified (ABMS) Physician Certified by ABSM: Sleep Medicine or ABMS: Sleep Medicine’ and associated technician qualification requirements revised to read: Credentialed by BRPT: RPSGT, ABRET: R. EEG T. (Polysomnography), CRT: SDS or RRT: SDS. In addition, “Vascular Surgeon” was added to the ‘Supervising Physician and Interpreting Physician Qualification Requirements’ section of ‘Credentialing Matrix’ for select CPT codes. The effective date of this revision is based on date of service.
02/02/2009 – Florida 03/02/2009 – Puerto Rico/Virgin Islands
Original
Coding Guidelines revised to add two sections, ‘Desk and Site Reviews’ and ‘Site Visits for Mobile Units and Electronic Monitoring Services’.
Page 35 of 35Coding Guidelines IDTF Independent Diagnostic Testing Facility
3/8/2009http://www.cms.hhs.gov/mcd/lcd_attachments/29956_1/IDTF.1_codeguideDRAFT.htm