MLN Matters Number: MM5815
Related Change Request (CR) #: 5815
Related CR Release Date: May 16, 2008
Effective Date: June 16, 2008
Related CR Transmittal #: R1504CP
Implementation Date: June 16, 2008

New Chapter in Medicare Claims Processing Manual for Independent Diagnostic Testing Facilities (IDTF)

Provider Types Affected
Independent Diagnostic Testing Facilities (IDTF) submitting claims to Medicare Administrative Contractors (A/B MAC) fiscal intermediaries (FI) or carriers for services provided to Medicare beneficiaries.

Impact on Providers
Change Request (CR) 5815 alerts providers to the fact that information from the Medicare Program Integrity Manual, Chapter 10, regarding claims processing instructions for IDTF’s is being excerpted and added to Medicare Claims Processing Manual via Chapter 35—a new chapter in the Medicare Claims Processing Manual. Currently, the Medicare Claims Processing Manual does not have claims processing instructions for IDTFs and this CR notifies providers of the availability of this information in that manual. No changes in policy are conveyed in CR5815.

Key Points of CR5815
Providers note that information regarding IDTF claims processing has been excerpted from the Medicare Program Integrity Manual, Chapter 10, and moved to the Medicare Claims Processing Manual, Chapter 35, which is a new chapter. The new Chapter 35 is available as an attachment to the official instruction of CR 5815. The new chapter contains information on the following:

• General coverage and payment policies applicable to IDTFs;
• Medicare’s definition of an IDTF;
• Claims processing instructions with emphasis on:
  • Billing issues;
  • Transtelephonic and electronic monitoring services; and
  • Slide preparation facilities and radiation therapy centers;
    • Ordering of tests;
    • Purchased diagnostic tests;
    • Interpretations of tests performed off the premises of the IDTF; and
    • Restrictions that do not allow billing for strictly therapeutic procedures.

IDTFs are reminded that the National Provider Identifier (NPI) of the ordering physician must be supplied in box 17B of the CMS-1500 form and in the appropriate loop of the ANSI X12 837P electronic claim format, effective for services on or after May 23, 2008.

Additional Information
To see the official instruction (CR5815) issued to your Medicare carrier, FI, or A/B MAC refer to http://www.cms.hhs.gov/Transmittals/downloads/R1504CP.pdf on the CMS Web site. As already mentioned, the new Chapter 35 of the Medicare Claims Processing Manual is attached to CR5815.

If you have questions, please contact your Medicare FI, A/B MAC, or carrier at their toll-free number which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.

Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.