New Medicare Requirements for "Advanced" Diagnostic Imaging


Beginning January 1, 2012, physician offices and other independent suppliers that furnish the technical component of advanced diagnostic imaging services must be accredited by a CMS-approved accreditation organization in order to receive payment under the Medicare Physician Fee Schedule.

CMS has designated three entities as nationally accredited organizations: the American College of Radiology, the Inter Societal Accreditation Commission and the Joint Commission Ambulatory Accreditation Program. These three organizations will provide accreditation services for suppliers wishing to qualify and bill for the technical component of advanced diagnostic imaging procedures. Hospitals are exempt from the new rules.

Advanced diagnostic imaging (ADI) procedures include magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging, including positron emission tomography (PET). Standard x-rays, fluoroscopy, and ultrasound are excluded from the requirement.

Any physician’s office or independent diagnostic testing facility(IDTF) that historically has provided ADI services must be accredited by January 1, 2012, or future Medicare claims will be denied. CMS estimates that the accreditation process will take up to five months and encourages suppliers to apply for accreditation immediately. Some of the quality standards that will be evaluated include...

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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