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:
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.
|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|
For the following modalities, use either the Pre-screening Form or the Privileging Application for Technical Diagnostic Imaging (if the group has an existing Technical Diagnostic Imaging Agreement and wishes to add a modality):
|Angiography||Specific criteria will depend upon CPT codes you want to perform|
|Bone densitometry||Registration from Massachusetts RCP|
|CT scan||Accreditation from the ACR|
|EVLT||Free-standing facility and hospitals
Accreditation from IAC or ACR
Review and report by a qualified radiation physicist that encompasses standards for safe operation of equipment and policies and procedures required for appropriate quality assessment and quality assurance
|MRI||Accreditation from ACR|
|Thyroid disorders||See Diagnostic Head and Neck Ultrasounds for Evaluation of Thyroid and Parathyroid Disorders|
|Vascular ultrasound||Accreditation from IAC or ACR|
For the modalities below, use the Technical Privileging Application:
|Obstetrical ultrasounds (limited/follow-up)||Accreditation from the AIUM or ACR|
|Ophthalmic A scans||None|
|X-ray||Review and report by a qualified radiation physicist that encompasses standards for safe operation of equipment and policies and procedures required for appropriate quality assessment and quality assurance|
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.
|Angiography||Specific criteria will depend upon CPT codes you request performing|
|Bone densitometry||Board certified in an approved specialty|
|CT scan||Board certified in an approved specialty
|Fluoroscopy||Board certified in in pain medicine and yearly attendance at a fluoroscopy safety course
|Mammography||Board certified in an approved specialty
|MRI||Board certified in an approved specialty and/or letter of inclusion in accreditation process|
|Ultrasound||Board certified in an approved specialty|
|Vascular ultrasound||Board certified in an approved specialty|
|X-ray||Board certified in an approved specialty|
|Other interventional||Specific criteria depends upon the CPT code requested|
For these modalities, use the applications shown in the right column:
|Modality||Professional requirements||Application to submit|
|EVLT||Physician and facility must be accredited for vein center by the Intersocietal Accreditation Commission|
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.
Just so you know....
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