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95951 EEG - Interpretation/Professional Component

Joshua Posted Tue 19th of June, 2018 12:39:43 PM
We are an IDTF that offers EEG services. I have a cardiologist that wants to order EEGs for patients with tachycardia, syncope, etc. to rule out neuro issues. Can the cardiologist read and bill for the 95951-PC component? Does the physician interpreting the 95951 have to be a Board Certified Neurologist to bill 95951-PC? Or can any MD interpret the study.. or if they interpret the study does a Board Certified Neurologist have to perform the over read?
SuperCoder Answered Wed 20th of June, 2018 03:15:26 AM

Hi,

The below link from CMS for IDTF says that for billing 95951, Neurologist should be the supervising physician. 

https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/31626_2/l31626_phys078_appendixa_020112.pdf

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ICN909060-IDTF-Fact-Sheet.pdf

Requirements for an IDTF Interpreting Physician:

IDTFs are not required to have interpreting physicians. If the IDTF does have such physicians, the IDTF interpreting physician must:

1. Be licensed to practice in the State(s) where the diagnostic tests he or she supervises will be performed

2. Be enrolled in Medicare

3. Not be currently excluded or barred

4. Be qualified to interpret the types of tests (codes) listed in the enrollment application  

Hope that helps!

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