Hospital and Skilled Nursing Facility Admission Diagnostic Procedures

Admission diagnostic procedures for hospital and skilled nursing facility patients are covered when specifically ordered by the admitting physician (or responsible facility staff physician), are medically necessary for the individual patient's diagnosis or treatment, and do not unnecessarily duplicate recent outpatient or prior facility testing. Tests furnished under physician standing orders or that duplicate recent identical tests are excluded; documentation must include the specific physician order and medical necessity, and prior test results when relevant.

"Diagnostic procedure is ordered specifically by the admitting physician or, where there is no admitting physician, by a hospital or skilled nursing facility (SNF) staff physician who has responsibi..."

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