71046
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.21
Facility
$2.70
Non-Facility
$2.70
Documentation Required
- Billing and coding guidance for chest X-ray must be used in conjunction with the associated Local Coverage Determination (LCD).
- Title XVIII of the Social Security Act, §1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.
- CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, §§100 and 100.1: Medicare will pay for the interpretation and report that directly contributes to the diagnosis and treatment of the individual patient.
- The IDTF must have Palmetto GBA provider enrollment approval listing the specific CPT/HCPCS codes the facility is authorized to bill for Medicare beneficiaries.
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.
12 Active Policies
L33693 — Peripheral Venous Ultrasound
J09
L37371 — Electroretinography (ERG)
J12
A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)
J12
L35007 — Vestibular and Audiologic Function Studies
J12
L35434 — Oximetry Services
Related Codes
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