Independent Diagnostic Testing Facility (IDTF) Enrollment

An IDTF may be a fixed location, a mobile entity, or an individual non-physician practitioner. It is independent of a physician's office or hospital; however, these rules apply when an IDTF furnishes diagnostic procedures in a physician's office. See the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 10.2.2.4 - IDTF Enrollment Standards.

A fixed IDTF (non-mobile or hospital based) cannot:

  • Share a practice location with another Medicare-enrolled individual or organization
  • Lease or sublease its operations or practice location to another Medicare enrolled individual or organization
  • Share diagnostic testing equipment used in initial diagnostic test with another Medicare-enrolled individual or organization
  • If contractor determines that an IDTF is leasing to subleasing its operations to another individual or organization, contractor shall revoke the supplier's Medicare billing privileges
  • If a group practice exists to solely provide professional component services for an IDTF's technical components and resides at same practice location at IDTF, group practice, and IDTF are not considered sharing space
    • Group practice shall not provide professional component services for any other organization

Access the below IDTF enrollment related information from this page.

How to Enroll

Initial Applications

  • An IDTF must complete the following applications.
    • If completing application via PECOS, select Create Initial Enrollment Application, select state in which services are rendered, finally; select Supplier Service type
      • A CMS-855B will populate with Attachment 2 and an EFT application will populate. See additional information below on what must be completed
    • CMS-855B with Attachment 2 completed for all CPT codes that will be used. Along with all interpreting physician's, supervising physician's and personnel (technician) that will be working for IDTF
    • CMS 588/EFT form
    • CMS 460/PAR form, for participation status in Medicare which is not a requirement for an IDTF to submit
  • A fee is required to be paid when submitting application
  • Must separately enroll each of its practice locations (with exceptions of locations that are used solely as a warehouses or repair facilities)
  • Can have only one practice location per application submitted, if an IDTF is adding a practice location to its existing enrollment, it must submit a new application for location that is being added to enrollment
  • If a fixed IDTF also contains a mobile unit, mobile unit must enroll separately from fixed location

Report a Change

  • Changes in ownership, changes of location, changes in general supervision, and final adverse actions must be reported to contractor within 30 calendar days of change. All other changes to enrollment application must be reported within 90 days
  • If an Interpreting Physician notifies Noridian that they no longer work at IDTF, Noridian will request a change application to be submitted removing physician
  • If a Supervising Physicians notifies Noridian that they no longer work at IDTF, Noridian will request a change application to be submitted removing physician
    • If IDTF does not submit an application to remove supervising physician, Noridian will proceed with non-compliance revocation of IDTF
    • If IDTF does not have another supervising physician, IDTF must submit a change of information adding a new supervising physician
  • If an IDTF adds equipment for diagnostic testing that is a mobile unit but is fixed permanently to IDTF's physical location. Example: A CT scanner that is mounted in a bus or trailer but is parked at IDTF's site for use by IDTF; a second enrollment is not needed. This equipment can be added as normal along with all CPT codes that will be used for equipment
  • If an IDTF undergoes an ownership change that results in a new enrollment in PECOS. Example: A new EIN and/or legal business name; Noridian will use original IDTF effective date

Effective Date

  • Date MAC contractor receives initial enrollment application is effective date of enrollment. (See 42 CFR §410.33(i).) Effective date of billing privileges for a newly enrolled IDTF is later of the following:
  • Filing date of Medicare enrollment application that was subsequently approved by a Medicare fee-for-service contractor
  • Date IDTF first started furnishing services at its new practice location

Mammography

  • If an IDTF furnishes any type of mammography services (screening or diagnostic), it must have a Food and Drug Administration (FDA) certification to perform the services.
    • An IDTF that only performs diagnostic mammography services should not be enrolled as an IDTF. This will be a Mammography Screening Center
  • A screening mammography (including those that are self-referred) is payable by Medicare when performed in and by an IDTF entity

Multi-State (Mobile)

  • A multi-state or mobile IDTF must be licensed in state(s) in which services are performed
    • Example: If mobile IDTF has a practice location in California and they see someone in Nevada. Mobile IDTF is not required to have a practice location in Nevada. Required to have a current license in state in which services where rendered. IDTF would not actually enroll in the state of Nevada, only in California.
  • Supervising physicians and technicians must be licensed in state(s) in which services are rendered
  • Enrollment is based on base of operations that is filled out in initial application that is submitted for mobile IDTF
  • Noridian must be able to determine when services are provided in a mobile facility or with portable units. A "mobile facility" is generally a mobile home, trailer, or other large vehicle that has been converted, equipped and licensed to render health care services. Patients are seen and/or treated INSIDE vehicle
  • Portable unit is when supplier transports medical equipment to a fixed location to render services to patient
  • In CMS-855B or PECOS web application, section 4F or Vehicle Information topic must be completed if IDTF is a mobile provider
    • If mobile health care services are rendered inside a vehicle, such as a mobile home or trailer, furnish following vehicle information. Do not provide information about vehicles that are used only to transport medical equipment (e.g., when the equipment is transported in a van but is used in a fixed setting, such as a doctor's office) or ambulance vehicles. If more than two vehicles are used, copy, and complete this section or topic, as needed. For each vehicle, IDTF must submit a copy of all health care related permits/licenses/registrations
  • Each trailer receives its own enrollment

Geographic Location (Mobile or Portable Services)

  • Actual location supplier renders services to Medicare patients in or from its mobile facility or portable unit
    • If applicant completed section 4 Mobile Services Information or selected Base of Operations in Physical location and "Special Payments" Address topic, this section must be completed

Leasing Equipment

  • IDTF is not required to report equipment that will be leased for a period less than 90 days

Supporting Documentation

  • A copy of IRS documentation with Legal Business Name (LBN) and EIN
  • If IDTF indicates they are a disregarded entity, a CP-575 form from IRS is not given. Noridian can accept any government form (such as a W-9) that lists LBN and EIN
  • If IDTF indicates they are nonprofit, a 501(c)3 document verifying its non-profit status must be submitted
  • CMS 460 PAR form or letter requesting non-par status
  • A diagram/flowchart for all entities listed in section 5. Must include relationships with supplier and each other
  • Voided check or a signed letter from the bank verifying bank information
    • Signed bank letter must include: LBN, practice location, routing and account number, and account type (Checking or savings)
  • Copy of comprehensive liability insurance meeting the following criteria:
    • At least $300,000 per location that covers both place of business and all customers and employees of IDTF
    • Policy must be carried by a non-relative-owned company
    • Maintain required insurance always. Failure to maintain required insurance always will result in revocation of IDTF's billing privileges retroactive to date insurance lapsed
    • Providing contact information for issuing insurance agent and underwriter
  • Copies of state license and/or certification for all technicians reported on application, if applicable
  • Additional attachments, if applicable, include:
    • FDA Certificate
    • For each vehicle, a copy of all health care related permits, licenses or registrations

Attachment 2

  • To add, change or delete codes, code along with piece of equipment and model number must be listed
    • If IDTF is billing for technical component only, modifier TC must be listed for any codes that may require it. Some codes are inherently TC only and do not require it. See CPT Codes for those that require the modifier

Providers

Position Criteria
Supervising Physicians
  • Supervising physicians must meet the following criteria:
    • Be licensed in state where diagnostic test is performed
    • Be enrolled in Medicare
      • If supervising physician is not enrolled with Medicare, an 855I must be sent in with CMS-855B application to add supervising physician to IDTF enrollment
        • CMS-855R is not required and will be returned
    • Meet proficiency tests for any tests that are supervised
    • Not currently revoked from Medicare
    • Each supervising physician must be limited to providing general supervision at no more than three (3) IDTF sites
      • Supervising physician is able to be either direct or personal at more than three (3) IDTF sites
  • For each physician performing General Supervision, at least one of the three functions listed must be listed in type of supervision section. This is a requirement in accordance with 42 C.F.R. 410.33(b), the enrolling IDTF must have at least one supervisory physician for each of the three functions:
    • Two physicians may be responsible for function 1, a third physician may be responsible for function 2, and a fourth physician may be responsible for function 3. All four supervisory physicians must complete and sign supervisory physician section of this application. Each physician should only check function(s) he/she performs
    • General – means procedure is furnished under the physician's overall direction and control, but the physician's presence is not required during the performance of the procedure. (phone call/email away)
    • Must indicate if supervising physician provides supervision at other IDTF locations. Each supervising physician must be limited to providing general supervision to no more than three IDTF sites. This applies to both fixed sites and mobile units where three concurrent operations can perform tests
    • The three functions that must be fulfilled by general supervising physician(s)
      1. Assumes responsibility for overall direction and control of quality of testing performed
      2. Assumes responsibility for assuring that non-physician personnel who perform diagnostic procedures are properly trained and meet required qualifications
      3. Assumes responsibility for proper maintenance and calibration of equipment and supplies necessary to perform diagnostic procedures
    • Direct – means physician must be present in office suite and immediately available to furnish assistance and direction throughout performance of procedure. It does not mean that physician must be present in room when procedure is performed (within suite)
    • Personal – means a physician must be in attendance in room during performance of procedure or possibly completing procedure themselves (in room)
  • If there are codes a supervising physician does not supervise, those must be listed in Attachment 2 Excluded CPT-4/HCPCS Codes data. All codes must be covered by at least one supervising physician
  • Supervising physician must sign application either on CMS-855B-paper application or via PECOS
Interpreting Physicians
  • An interpreting physician must meet the following criteria:
    • Be licensed as an interpreting physician
    • Be enrolled in Medicare
      • If supervising physician is not enrolled with Medicare, a CMS-855I must be sent in with CMS-855B application to add supervising physician to IDTF enrollment
        • CMS-855R is not required and will be returned
    • Meet proficiency tests for any tests that are supervised
    • Not currently revoked from Medicare
    • Be qualified to interpret types of tests (Codes) listed in enrollment application
    • Attachment 2 must be completed for all interpreting physicians for IDTF if intending to bill globally
    • Interpreting Physicians can also be enrolled as a Supervising Physician on same enrollment
Technician
  • An IDTF technician must meet the following criteria:
    • Meet certification and /or license standards of state in which tests are performed at time of IDTF enrollment and/or at time any tests are performed
    • Technician(s) must be either credentialed by a national credentialing body or licensed by state, whichever codes IDTF intends to bill for requires
    • Copy of certification or licensure should be included with application for all technicians
  • All technicians for IDTF must be reported in attachment 2

 

Resources

 

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