Search
Home  >  Office Resources  >  Enrollment  >  Privileging 
Web Content Viewer (JSR 286)
Privileging

We privilege providers who perform diagnostic imaging services.

To receive reimbursement, all professional providers, technical providers, and non-hospital-based free-standing facilities must have privileges for the following diagnostic imaging services:

  • Angiography
  • Bone densitometry
  • Cardiac CT Scan
  • Endovenous laser treatment
  • Fluoroscopy
  • Mammography
  • MRI
  • Nuclear Medicine, including PET scan
  • Opthalmic B scans
  • Ultrasound (general, breast, vascular, thyroid)
  • X-ray

We apply separate and distinct reimbursement criteria to technical providers—who perform imaging services—and professional providers—who read and interpret the images.

Technical services providers:   Perform imaging services for modality-specific procedure code ranges for the equipment used.
Professional services providers:   Perform interpretations for procedure code ranges specific to their specialty and medical training.

Once you are credentialed and enrolled with us, if your credentialed specialty is on the list of privileged specialties and modalities, you are privileged only for those codes associated with that specialty and do not need to complete a professional privileging application.

If you want to use a code (from the list) that is not associated with your credentialed specialty, submit the Exception Request Form and the applicable associated documents.

Expand All
Acronym key
ACR  American College of Radiology
AIUM  American Institute of Ultrasound Medicine
CPT  Current procedural terminology
EVLT  Endovenous laser treatment
IAC  Intersocietal Accreditation Commission
MRI  Magnetic resonance imaging
PET  Positron emission tomography
RCP  Radiation control program certificate through the Department of Public Health  
Apply to provide technical services
  • You can apply to be reimbursed for costs for owning, leasing, or use of diagnostic imaging for the services listed below.
  • Complete a separate application for each location where you own, lease, or otherwise incur the full usage cost of diagnostic imaging equipment for any of the modalities listed below.
  • If there are changes to the diagnostic imaging equipment or service site information, submit a new copy of the application with an explanation attached.

For the modalities below, use the Limited Technical Privileging Application:

Modality Technical requirements
Obstetrical ultrasounds (limited/follow-up) Codes 76815 and 76816
Ophthalmic A scans Codes 76511 and 76516
X-ray See page 7 of the TDI Privileging Application

For the following modalities, use the TDI Privileging Application:

Modality Technical requirements
Angiography Specific criteria will depend upon CPT codes you want to perform
Bone densitometry Registration from Massachusetts DPH Radiation Control Program
Cardiac CT scan Accreditation from the American College of Radiology or the Intersocietal Acred. Comm. of Computerized Tomography (IAC CT)
Endovenous laser treatment Free-standing facility and hospitals
Accreditation from IAC
Fluoroscopy See list
Mammography Accreditation (or application for accreditation) from IAC or ACR mammography program
Magnetic Resonance Imaging (MRI) Accreditation from IAC or ACR
Nuclear medicine (including nuclear cardiology and PET scans)
  • Nuclear Regulatory Commission license and/or
  • Registration from the Massachusetts DPH Radiation Control Program
Opthalmic No requirements, but contract needed
Ultrasound, breast Accreditation from either AIUM or ACR
Ultrasound, general
  • Accreditation from either AIUM or ACR
  • Ultrasonic guidance CPT 76942 is classified in the modality of ultrasound.
    • Specific procedure training and competence as assessed by qualified proctor (a physician who has exceptional documented training in the relevant area to be assessed capable of supervision and assessment) through review of real time procedure
    • On-going QA/QC assessment procedures and complication rates
    • Reporting should be in accordance with the AIUM Practice Guideline for Documentation of an Ultrasound Examination
Ultrasound, thyroid See Diagnostic Head and Neck Ultrasounds for Evaluation of Thyroid and Parathyroid Disorders
Ultrasound, vascular Accreditation from IAC or ACR
Apply to provide professional services

You can apply to be reimbursed for diagnostic imaging interpretation for the services listed below.

For the following modalities, use the Diagnostic Imaging Professional Privileging Application.

Modality Professional requirements
Angiography Specific criteria will depend upon CPT codes you request performing
Bone densitometry Board certified in an approved specialty
Cardiac CT scan Please see Consensus Criteria Permitting a Radiologist to Officially Interpret Cardiac CT (CCT) Studies
Fluoroscopy Board certified in in pain medicine and yearly attendance at a fluoroscopy safety course
  • If hospital-based:
    • Sign-off by the chief of radiology at the affiliated hospital
  • If free-standing facility:
    • Letter of inclusion in accreditation process
Magnetic Resonance Imaging (MRI) Board certified in an approved specialty and/or letter of inclusion in accreditation process
Mammography Board certified in an approved specialty
  • If hospital-based:
    • Sign-off by the chief of radiology at the affiliated hospital
  • If free-standing facility:
    • Letter of inclusion in accreditation process
Opthalmic Board certified in an approved specialty
Other interventional Specific criteria depends upon the CPT code requested
Ultrasound, general Board certified in an approved specialty
Ultrasound, thyroid Board certified in an approved specialty (for training criteria, see Diagnostic Head and Neck Ultrasounds for Evaluation of Thyroid and Parathyroid Disorders)
Ultrasound, vascular Board certified in an approved specialty
X-ray Board certified in an approved specialty

For these modalities, use the applications shown in the right column:

Modality Professional requirements Application to submit
Nuclear Medicine (including nuclear cardiology and PET scans)
Endovenous laser treatment Physician and facility must be accredited for vein center by the Intersocietal Accreditation Commission
Appeals

If you perform interpretation services for additional services beyond what your specialty is privileged for, your claims will be denied. You must submit an appeal for further consideration. 

  • Use the Diagnostic Imaging Professional Privileging Application to specifically request the privilege to be reimbursed for additional CPT codes beyond your specialty.
  • Be sure to include documentation of your education, additional training, and volume of studies.
  • Certain diagnostic imaging services performed in a hospital setting may require submission of a letter from the chief of radiology attesting to the hospital privileges of the individual provider involved in the appeal. The letter should also include recognition of the provider's appropriate course of training for the interpretation of the procedure.
  • X-ray and fluoroscopy require a documented review and report by a qualified radiation physicist that encompasses standards for safe operation of equipment, policies, and procedures required for appropriate quality assessment and quality assurance. Documentation requirements follow standards developed by the American College of Radiology (www.acr.org).
  • To request a privileging exception, fill out and send the Privileging Exception Request Form.
Questions?
For privileging application questions, call Network Management & Credentialing Services at
1-800-316-BLUE (2583).
  •  
  • Related Content
  •  
Web Content Viewer (JSR 286)