IDTF CPT Codes and the professional requirements for that code in particular.

This article provides information regarding CPT/HCPCS codes that describe diagnostic procedures (and some materials required to perform the diagnostic procedures, i.e., radioactive tracers) that may be performed in an independent diagnostic testing facility (IDTF).

Coding Guidelines

In order for an IDTF to be reimbursed by Medicare for any procedure or material included in this article, that specific IDTF must be credentialed and approved by Palmetto GBA provider enrollment to bill for that specific service when provided to a Medicare beneficiary.

The information in this article may not be all-inclusive and may be subject to change as CPT/HCPCS codes are updated. The codes included in this article are based on the latest coding updates. The effective date of this article is the date of the most recent update.

With these updates certain codes may be deleted but will still be appropriate for billing up to 1 year after the procedure date. A listing of these codes that may still be valid are located in the Other Coding Information section of this article.

The listing of a procedure code does not guarantee that Medicare will reimburse the service. All services are subject to Medicare medical necessity and coverage policies, including National Coverage Decisions, Local Coverage Decisions, statutory exclusions and instructions in interpretive manuals.

It is not appropriate to bill Medicare for services that are not covered as if they are covered. When billing for non-covered services, use the appropriate modifier.

Additional Services/Supplies

Additional services/items (e.g., radiopharmaceutical agents, special contrast agents, medications, etc.) are considered supplies and are also payable to an IDTF if they are commonly separately reimbursed to a physician in a physician’s office setting. They are not listed in this article, in that if the test is payable, the supplies will be also.

Physician Supervision of Diagnostic Procedures


The following list defines the numeric level of physician supervision for diagnostic procedures assigned to each CPT/HCPCS code and is located in the Medicare Physician Fee Schedule Database (MPFSDB) .

1 = General supervision of a physician

2 = Direct supervision of a physician

3 = Personal supervision of a physician

4 = Physician supervision does not apply if performed by a qualified independent psychologist or a clinical psychologist; otherwise general supervision of a physician is required

5 = Physician supervision does not apply if performed by a qualified audiologist; otherwise general supervision of a physician is required

6 = Must be personally performed by a physician or by a physical therapist (PT) who is certified by the American Board of Physical Therapy Specialties (ABPTS) as a qualified electrophysiologic clinical specialist and is permitted to provide the service under state law

66 = May be performed by a physician or a physical therapist with ABPTS certification and certification in this specific procedure

6A = Supervision standards for level 66 apply; in addition, the PT with ABPTS certification may supervise another PT, but only the PT with ABPTS certification may bill

21 = Procedure may be performed by a technician with certification under general supervision of a physician; otherwise must be performed under the direct supervision of a physician

22 = May be performed by a technician with on-line real-time contact with a physician

77 = Procedure must be performed by a PT with ABPTS certification (TC & PC) or by a PT without certification under direct supervision of a physician (TC & PC), or by a technician with certification under general supervision of a physician (TC only; PC always physician)

7A = Must be personally performed by a physical therapist (PT) who is certified by the American Board of Physical Therapy Specialties (ABPTS) or by a PT without certification under direct supervision of a physician, or by a technician with certification under general supervision; in addition, the PT with ABPTS certification may supervise another PT, but only the PT with ABPTS certification may bill

9 = 26 /TC indicator not applicable - concept of a professional/technical component does not apply

Qualification requirements: IDTF Supervising Physician

Licensed to practice in the state(s) in which the diagnostic tests he or she supervises will be performed
Enrolled in Medicare
Meets the proficiency standards for any tests he or she is supervising
Not currently excluded or barred
Provides general supervision for no more than three IDTF sites

Qualification requirements: IDTF Interpreting Physician

Licensed to practice in the state(s) in which the diagnostic tests he or she interprets will be performed
Enrolled in Medicare
Not currently excluded or barred
Qualified to interpret the types of tests (codes) listed in the enrollment application

Qualification requirements: IDTF Technician

Meets the licensure and/or certification standards of the state in which tests are performed at the time of the IDTF’s enrollment and/or at the time any tests were performed
Qualified to perform the types of tests (codes) listed in the enrollment application, read more here.