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Which diagnostic imaging services require an order or referral?

Hilde Posted Fri 05th of April, 2013 23:01:03 PM

I am aware that Medicare's ordering/referring provider edits will be activated on May 1. Where can I find a list or an indicator to tell me exactly WHICH diagnostic imaging service codes require the info? We usually provide the referring physician info for things like Ascans '76519', masters '92136', topography '92025', etc., but I'd like to know where to look to know for sure. I have looked everywhere and can't find an answer.

SuperCoder Answered Mon 08th of April, 2013 15:04:13 PM

Please go through the following CMS site for complete information about Edits on the Ordering/Referring Providers to be implemented from May 1st 2013

Hilde Posted Tue 09th of April, 2013 23:34:04 PM

I already read that. That does not have a listing of the CPT codes that require an order or referral.

SuperCoder Answered Wed 10th of April, 2013 14:37:09 PM

Effective May1, you need a Physician order/referral for MCR covered imaging services. MCR covers X-rays, including portable x-rays; Computerized Axial Tomography (CAT) procedures, including portable CT procedures; (MRI) procedures; Magnetic Resonance Angiography (MRA) procedures; Nuclear Medicine Imaging procedures and radionuclides used in the procedures; Diagnostic mammography and certain screening mammography; Ultrasound (US) diagnostic procedures; PET and diagnostic imaging agents; PET for certain oncologic conditions; Radiation Oncology; and Bone Mass Measurements.

Hilde Posted Tue 30th of April, 2013 15:05:50 PM

Those are categories. I'm looking for a listing of the specific codes...

SuperCoder Answered Tue 30th of April, 2013 15:23:24 PM

Let us check out for you.


SuperCoder Answered Thu 02nd of May, 2013 10:32:37 AM

Please note that MCR has not created any such comprehensive list of codes. However as per these edits, MCR wants that imaging centers must accept orders or referrals only from those physicians or Non-Physicians who have current Medicare enrollment records and are of a type/specialty that is eligible to order or refer in the Medicare program. So, it is advisable to put correct Referring Provider information on all claims billed to MCR. Also note that Optometrists may only order and refer DMEPOS products/services and laboratory and X-Ray services payable under Medicare Part B.

Hilde Posted Fri 03rd of May, 2013 17:41:32 PM

Thanks anyway.

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