0652T — Egd flx transnasal dx br/wa
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- This billing and coding guidance complements Local Coverage Determination L34434; follow LCD L34434 for clinical coverage criteria and required documentation for claims.
- All services billed with unlisted procedure codes must include sufficient medical records and supporting documentation to allow development and medical review.
- The IDTF must have Palmetto GBA provider enrollment approval listing the specific CPT/HCPCS codes the facility is authorized to bill for Medicare beneficiaries.
- Claims must be supported by documentation showing the supervising and interpreting physicians are licensed in the state(s) of service, enrolled in Medicare, not excluded, and meet any stated proficiency or specialty requirements.
Key Coverage Criteria
- An IDTF must be credentialed and approved by Palmetto GBA provider enrollment to bill Medicare for a specific diagnostic procedure or material.
- Additional services and supplies (e.g., radiopharmaceuticals, special contrast agents, medications) are payable to an IDTF when the diagnostic test itself is payable and the supplies are commonly separately reimbursed to a physician in an office setting.
- A supervising physician for an IDTF must be licensed in the state(s) where tests are performed, enrolled in Medicare, not excluded, meet proficiency standards for tests supervised, and provide general supervision for no more than three IDTF sites.
- An interpreting physician must be licensed in the state(s) where tests are performed, enrolled in Medicare, not excluded, and qualified to interpret the types of tests (codes) listed on the IDTF enrollment application.
- An IDTF technician must meet applicable state licensure and/or certification standards at the time of enrollment and/or at the time tests are performed and be qualified to perform the types of tests (codes) listed in the enrollment application.
- For each CPT/HCPCS code listed in the policy, the supervising physician and technician must meet the specialty and certification qualifications specified in the policy’s code-to-qualification mapping to be reimbursable by Medicare.
3 Active Policies
A56389 — Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization
A58559 — Billing and Coding: Independent Diagnostic Testing Facilities (IDTF)
L34434 — Upper Gastrointestinal Endoscopy and Visualization
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.