2015 HIP Outpatient Diagnostic Imaging Self-Referral Payment Policy

2015 HIP Outpatient Diagnostic Imaging Self-Referral Payment Policy

2015 HIP Outpatient Diagnostic Imaging Self-Referral Payment Policy
Effective January 1, 2015

Provider Specialty

CPT Codes

Description

Accreditation 
Requirement(s)

Primary Care Physicians (includes Internal Medicine, Family Practice)

71010 -71030

Chest imaging

No additional requirements

77080, 77081, 770853

DEXA studies, bone densitometry
933031, 933041, 933061- 933081 Transthoracic echocardiography 1. National Board of Echocardiography (NBE) certification
2. Laboratories accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (IAC Echocardiography) 3
933501, 933511

Doppler echocardiography, add on codes

Cardiologists (includes Cardiovascular Disease, Interventional Cardiologists, Cardiac Electrophysiologists)

71010 - 71030 Chest imaging

No additional requirements

76930 Ultrasonic guidance for pericardiocentesis
 76932 Ultrasonic guidance for endomyocardial biopsy
 933031, 933041, 933061– 933081 Transthoracic echocardiography 1. Cardiology certification by the American Board of Internal Medicine (ABIM) or American Osteopathic Board of Internal Medicine(AOBIM) 
2. Laboratories accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (IAC Echocardiography) 3
 93320, 93321, 93325 Doppler echocardiography, add on codes
 933501, 933511 Stress echocardiography

Cardiologists, Nuclear

784511, 784521, 784531, 784541 Myocardial perfusion imaging

1. Certification by the American Board of Radiology (ABR), American Board of Nuclear Medicine(ABNM) or Certification Board of Nuclear Cardiology (CBNC)
2. Laboratories accredited by the Intersocietal Commission for the Accreditation of Nuclear Laboratories (IAC Nuclear/PET)3 or American College of Radiology (ACR)

784661, 784681, 784691 Myocardial infarction scans
784721, 784731, 784811, 784831, 784941 Cardiac blood pool imaging
76930 Ultrasonic guidance for pericardiocentesis
76932 Ultrasonic guidance for endomyocardial biopsy

Pediatric Cardiologists

768252 - 768282 Echocardiography, fetal

1. Certification in pediatric cardiology by the American Board of Pediatrics 
2. Laboratories accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (IAC Echocardiography) 3

715551 MRA chest
755571 - 755631 Cardiac MRI
71010 - 71030 Chest imaging
76930 Ultrasonic guidance for pericardiocentesis
76932 Ultrasonic guidance for endomyocardial biopsy
933031, 933041, 933061 to 933081 Stress echocardiography
933501 , 93351 Transesophageal echocardiography
93320, 93321, 93325 Doppler echocardiography, add on codes

Chiropractors

72010, 72040, 72069, 72070, 72080, 72100

Spine imaging

No additional requirements

Colon and Rectal Surgeons

76872

Ultrasound, transrectal

Must be board certified by the American Board of Colon and Rectal Surgery(ABCRS) to perform this ultrasound

76942 Ultrasonic guidance for biopsy only

Endocrinologists

77080,77081, 770853

DEXA studies, bone densitometry

No additional requirements

76536

Thyroid ultrasound

Endocrine Certification in Neck Ultrasound (ECNU) from the American Association of Clinical Endocrinologist (AACE) 
5 Effective 1/1/16: American Institute of Ultrasound in Medicine(AIUM) accreditation in thyroid/ parathyroid ultrasound

76942 Ultrasonic guidance for biopsy

Gastroenterologists

76975

Endoscopic ultrasound

No additional requirements

General Surgeons

75962 Transluminal balloon angioplasty

No additional requirements

Breast Surgeons

76942

Ultrasonic guidance for biopsy

4 Effective 9/1/15: For breast ultrasound and ultrasound guided breast biopsy: Physicians must be certified in breast ultrasound by the American Society of Breast Surgeons(ASBS) and: 
Facilities must have accreditation from the ASBS for breast ultrasound and ultrasound guided breast biopsy; or Accredited by the Am. College of Radiology in breast ultrasound and ultrasound guided biopsy; or Accredited by AIUM in interventional breast ultrasound

766413

Breast ultrasound, complete

766423 Breast ultrasound, limited

Geriatricians

71010 - 71030

Chest imaging

No additional requirements

933031, 933041, 933061 to 933081

Transthoracic echocardiography

Non-cardiologists: 
1. National Board of Echocardiography (NBE) certification 
2. Laboratories accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (IAC Echocardiography) 3

93320, 93321, 93325 Doppler echocardiography, add on codes

Hand Surgeons

76000

Fluoroscopy

No additional requirements

73100 - 73140 Upper extremity imaging

Head and Neck Surgeons (includes ENT, Otolaryngologists)

76942, 76536

Ultrasonic guidance for biopsy only

No additional requirements Effective 9/1/15: AIUM accreditation in head and neck ultrasound

Hematologist/Oncologists Medical Oncologists Oncologists

71010 - 71030

Chest imaging

No additional requirements

Maternal and Fetal Medicine

77052 Computer-aided detection of radiographic images

Must be fully compliant with Mammography Quality Standards Act(MQSA) requirements to perform screening mammography

77057, G0202 Screening mammography
770633 Screening tomosynthesis

74740

Hysterosalpingography

No additional requirements

77080, 77081, 770853 DEXA studies, bone densitometry
768152, 768162, 768172, 768202, 768212, 76830 – 76857, 76930, 76941, 76942, 76945, 76946, 76948 Ultrasound: obstetrical, pelvic, guidance
768012, 768022, 768052, 768102, 768112, 768122, 768132, 768142, 768182, 768192, 768202, 768212, 768252, 768262, 768272, 768282 Ultrasound: obstetrical/pelvic guidance AIUM/ACR Accreditation
76970 Ultrasound study, follow-up
93325 Doppler echocardiography, add on

Nephrologists

75791 Angiography arteriovenous shunt, radiological supervision and interpretation

No additional requirements

75978 Venous angioplasty, radiological supervision and interpretation
77021 MR guidance for needle placement
77012 CT scan for needle biopsy
77002 Needle localization by x-ray
76942 Ultrasonic guidance for biopsy
759623 Transluminal balloon angioplasty

Nuclear Medicine

780121, 780131, 780141, 780151, 780161, 780181, 780201, 780701, 780711, 780721, 780751, 781021, 781031, 781041, 78110, 78111, 78120, 78121, 78122, 78130, 78135, 78140, 781851, 78190, 78191, 781951, 782011, 782021, 782051, 782061, 782151, 782161, 782261, 782271, 782301, 782311, 782321, 782581, 782611, 782621, 782641, 78270, 78271, 78272, 782781, 782821, 782901, 782911, 783001, 783051, 783061, 783151, 783201, 785791, 785801, 78582 1, 785971,785981, 786001, 786011, 786051, 786061, 786071, 786101, 786301, 786351, 786451, 786471, 786501, 786601, 787001, 787011, 787071, 787081, 787091, 787101, 787251, 787301, 787401, 787611, 788001, 788011, 788021, 788031, 788041, 788051, 788061, 788071, 78808, 788111, 788121, 788131, 788141, 788151, 788161

Nuclear medicine studies

Physicians certified by the American Board of Radiology (ABR) or the American Board of Nuclear Medicine (ABNM)

Obstetrics and Gynecology 77052 Computer aided detection of radiographic images

No additional requirements

77057, G0202 Screening Mammography
770633 Screening tomosynthesis
77080, 77081, 770853 DEXA studies, bone densitometry
74740 Hysterosalpingography
76830 to 76857, 768152, 768162, 768172 Ultrasound : obstetrical, pelvic
76930 Ultrasound study, follow-up Guidance
76941 Ultrasonic guidance for fetal transfusion or cordocentesis
76945 Ultrasonic guidance for chorionic villus sampling
76946 Ultrasonic guidance for amniocentesis
76948 Ultrasonic guidance for aspiration of ova
76970 Ultrasound study, follow-up

768012, 768022, 768052, 768102, 768112, 768122, 768132, 768142, 768182, 768192, 768202, 768212, 768252, 768262, 768272, 768282

Ultrasound: obstetrical, pelvic
93325

Doppler echocardiography

Oral Surgeons

70100, 70110, 70140, 70150 Mandible and facial bone imaging

No additional requirements

70300, 70310, 70320 Teeth imaging
70328, 70330 TMJ imaging
70350 Cephalogram, orthodontic
70355 Orthopantogram

Orthopedists (includes Pediatric Orthopedists, Orthopedic Surgeons and Pediatric Orthopedic Surgeons)

71100 - 71111

Radiologic examination, ribs

No additional requirements

71120 - 71130 Radiologic examination, sternum
72010 - 72120,72170, 72190 72200 - 72220 Spine and Pelvis imaging
73000 - 73140, 73500 - 73660 Imaging to Upper and lower extremities
76000, 77002, 77003 Fluoroscopy
77071 Radiologic examination, any joint
77073 Bone length studies
77077 Joint survey
76881 Ultrasound, extremity

AIUM accreditation in musculoskeletal ultrasound

76882 Ultrasound, extremity, limited
76885 Ultrasound, infant hips
76886 769423 Ultrasound, infant hips, limited Ultrasonic guidance for needle placement

Pain Specialists (includes Physiatrists, Anesthesiologists, Neurologists, Neurosurgeons, Physical Medicine and Rehabilitation)

72275

Epidurography, radiological supervision and interpretation

No additional requirements

76000, 77002, 77003 Fluoroscopy

Pediatricians

71010–71030

Chest imaging

No additional requirements

Podiatrists

73600, 73610, 73620, 73630, 73650, 73660

Lower extremity imaging

No additional requirements

769424 Ultrasonic guidance for needle placement
768814 Ultrasound, extremity
768824 Ultrasound, extremity, limited

Pulmonologists

71010–71030

Chest imaging

No additional requirements

Radiation Oncologists

77012 Computed tomography guidance for needle placement

No additional requirements

77014 Computed tomography guidance for placement of radiation therapy fields
76873 Prostate volume study for brachytherapy treatment planning
76950 Ultrasonic guidance for placement of radiation therapy fields
76965 Ultrasonic guidance for interstitial radioelement application
76942 Ultrasonic guidance for biopsy only

Reproductive Endocrinologists

77052 Computer aided detection of radiographic images

Must be fully compliant with MQSA requirements to perform screening mammography

77057, G0202 Screening Mammography
770633 Screening tomosynthesis

77080, 77081, 770853

DEXA studies, bone densitometry

No additional requirements

768152, 768162, 768172, 76830 to 76857 Ultrasound – obstetrical, pelvic
76948 Ultrasonic guidance for aspiration of ova
76970 Ultrasound study, follow-up
74740 Hysterosalpingography
768012, 768022, 768052, 768102, 768112, 768122, 768132, 768142, 768182, 768192, 768202, 768212, 768252, 768262, 768272, 768282

Ultrasound: obstetrical, pelvic, guidance

AIUM/ACR Accreditation

76941 Ultrasonic guidance for fetal transfusion or cordocentesis
76942 Ultrasonic guidance for biopsy
76945 Ultrasonic guidance for chorionic villus sampling
76946

Ultrasonic guidance for amniocentesis

93325 Doppler echocardiography, add on

Rheumatologists

72010 - 72120,72170, 72190 72200 - 72220

Spine and pelvis imaging

No additional requirements

73000 - 73140, 73500 - 73660 Imaging- Upper and lower extremities
76000, 77002 Fluoroscopy
77073, 77077 Bone length studies, joint survey
77080, 77081, 770853 DEXA studies, bone densitometry

76881

Ultrasound, extremity

AIUM accreditation in musculoskeletal ultrasound

76882 Ultrasound, extremity, limited
76885 Ultrasound, infant hips
76886 Ultrasound, infant hips, limited
76942 3 Ultrasonic guidance for needle placement

Sports Medicine

71100 - 71111 Radiologic examination, ribs

Board certification in sports medicine and combined fellowship, residency and training in sports medicine of at least four years

71120 - 71130 Radiologic examination, sternum
72010 - 72120, 72170, 72190, 72200 - 72220 Spine and pelvis imaging
73000 - 73140, 73500 - 73660 Imaging to upper and lower extremities

76881

Ultrasound, extremity

AIUM accreditation in dedicated musculoskeletal ultrasound

76882 Ultrasound, extremity, limited
769423 Ultrasonic guidance for needle placement

Urologists

74455 Urethrocystography

No additional requirements

76775 Ultrasound, limited 4 Effective 9/1/15: AIUM accreditation in urologic ultrasound
76870, 76872, 76873 Ultrasounds - scrotum, Transrectal Prostate volume study for brachytherapy treatment planning
76942 Ultrasonic guidance for biopsy only
76857 Ultrasound pelvic limited or follow up

Vascular Neurology

76125 Cineradiography/video radiography

ABMS Certification in Vascular Neurology

75898 Angiography through existing catheter
75896 Transcatheter therapy, infusion
75894 Transcatheter therapy, embolization
75685 Angiography, vertebral, cervical and/or intracranial
75680 Angiography, carotid, cervical, bilateral
75676 Angiography, carotid, cervical, unilateral
75671 Angiography, carotid, cerebral, bilateral
75665 Angiography, carotid, cerebral, unilateral
75662 Angiography, external carotid, bilateral, selective
75660 Angiography, external carotid, unilateral, selective
75600 Aortography, thoracic, without serialography

Vascular Surgeons

77001

Fluoroscopic guidance for central venous access device

No additional requirements

76937 US guidance for vascular access

 

Note: This policy does not apply to IPA services rendered in Putnam and Ulster Counties

1 These procedures require pre-certification; call 1-866-417-2345

2 Any studies beyond three require pre-certification; call 1-866-417-2345

3 Procedure Code Changes effective 1/1/15

4 Changes effective 9/1/15:

  • General Surgeons must have individual ASBS certification; facilities must have accreditation from ASBS, or ACR or AIUM
  • Head and Neck Surgeons must have accreditation in Head and Neck Ultrasound from AIUM
  • Podiatrist must have accreditation in Dedicated Musculoskeletal Ultrasound from AIUM
  • Urologist must have accreditation in Urologic Ultrasound from AIUM

5 Changes Effective: 1/1/16:

  • Endocrinologist must have accreditation in Dedicated Thyroid/Parathyroid Ultrasound from AIUM
Chapter 21 Hip Outpatient Diagnostic Imaging Referral Payment Policy