Radiology - JE Part B
Radiology
Medicare generally covers x-rays, including portable x-rays, fluoroscopy and mammography; CT, including portable CT, CT angiography (CTA) and CT-guided procedures; MRI, including MR angiography (MRA) and MRI-guided procedures; ultrasound (US), including diagnostic grey-scale and vascular Doppler imaging, and US-guided procedures; nuclear medicine diagnostic imaging and procedures, including radionuclides and PET for certain conditions; radiation oncology; and bone density (DEXA) scans. Coverage may be limited to certain indications.
Medicare covers imaging services that are performed or supervised by a physician who is certified or eligible to be certified by the American Board of Radiology or authorized by scope of practice and applicable State Law.
Nurse practitioners, clinical nurse specialists, and physician assistants are authorized to personally perform diagnostic tests as provided under §1861(s)(2)(K) of the Act. These practitioners must meet the supervision requirements applicable to their practitioner benefit category pursuant to State scope of practice laws and under the applicable State requirements.
Licensed Supervising Providers
The following are authorized to supervise the performance of diagnostic tests in addition to physicians:
- Nurse Practitioner (NP)
- Clinical Nurse Specialist (CNS)
- Physician Assistant (PA)
- Certified Registered Nurse Anesthetist (CRNA)
- Certified Nurse Midwife (CNM)
Level of Supervision - levels assigned by each CPT or HCPCS code in the Medicare Physician Fee Schedule Database
- General Supervision - means the 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. Under general supervision, the training of the nonphysician personnel who actually performs the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician.
- Direct Supervision - in the office setting means the physician (or other supervising practitioner) must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician (or other supervising practitioner) must be present in the room when the procedure is performed.
- Personal Supervision - means a physician must be in attendance in the room during the performance of the procedure.
'Incident To' benefits
Diagnostic tests need not meet the incident to requirements because the diagnostic tests benefit set forth in §1861(s)(3) of the Act is separate and distinct from the incident to benefit set forth in §1861(s)(2) of the Act. Diagnostic tests can't be billed to Medicare as incident to services. Accordingly, the supervision requirements under the incident to benefit category aren't applicable to the diagnostic tests benefit category.
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