Independent Diagnostic Testing Facility

General Information

Certain diagnostic services provided by an IDTF are considered for Medicare payment when medically necessary.

A referring/treating provider must order all covered services. The treating physician or nonphysician practitioner is the provider responsible for the management of the patient’s specific medical problems.

An IDTF

  • is independent both of an attending or consulting physician’s office and hospital;
  • provides only noninvasive diagnostic tests at the written order of an attending or consulting physician who is independent of the IDTF;
  • is independent of a physician’s office or hospital and is not owned by a hospital, individual physician or group practice of physicians and its purpose is to furnish diagnostic tests and not to directly use test results to treat a patient;
  • operates its business in compliance with all applicable federal and state licensure and regulatory requirements for the health and safety of patients.

National Government Services shall not grant billing privileges to any business not appropriately licensed as required by the state or federal agency. Billing privileges will be revoked and appropriate recoupment actions will be taken for providers not properly licensed.

An IDTF must

  • separately enroll each of its practice locations, which means an enrolling IDTF can only have one practice location on the initial enrollment application, PECOS or CMS-855B;
  • submit a new application for that location, pay an application fee and have that location undergo a separate site visit, if an IDTF is adding a practice location to its existing enrollment. For more information on credentialing as an IDTF, please see IDTF Credentialing, Enrollment and Revalidation.

The IDTF applicant shall

  • list all physicians for whose diagnostic test interpretations it will bill and these physicians shall be enrolled as individual Medicare providers. This includes physicians who will provide interpretations subject to the anti-markup payment limitation as detailed in CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 30.2.9, whether the service is provided to the IDTF on a contract basis;
  • employ or contract with an interpreting physician do not reassign benefits when submitting IDTF application(s);
  • meet performance standards in order to obtain or maintain their Medicare billing privileges. These are verified during the site visit. These standards, in their entirety, can be found in Federal Register 42 CFR Public Health 416.5, 410.33 42 CFR Section 410.33(g);
  • submit supervisory/interpreting physician(s) shall submit copies of all documentation verifying proficiency (resume) and state licenses or certification;
  • submit technician' documentation verifying their certification(s).

Related Content11/16/202310/23/2024

Reviewed 10/23/2024