New CMS Specialty Code for Advanced Diagnostic Imaging Services

November 24, 2010

Effective April 1, 2011, CMS (the Centers for Medicare & Medicaid Services) will require that a new specialty code for advanced diagnostic imaging services be reported.  This new specialty code 95 will be required to be reported to Medicare carriers, fiscal intermediaries, or Medicare Administrative Contractors (MAC) for providing diagnostic imaging services to Medicare beneficiaries. 

MIPPA (the Medicare Improvements for Patients and Providers Act of 2008) specifically defines advanced diagnostic imaging procedures as including diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET).  The Secretary, Health and Human Services, is required under the act to designate organizations to accredit suppliers, including but not limited to physicians, non-physician practitioners and independent diagnostic testing facilities, that furnish the technical component of advanced diagnostic imaging services.  MIPPA expressly excludes from the accreditation requirement x-ray, ultrasound, and fluoroscopy procedures, as well as diagnostic and screening mammography.  In order to furnish the specialty code for advanced diagnostic imaging services for Medicare beneficiaries suppliers must be accredited by January 1, 2012.

The CMS approved three national accreditation organizations – the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission - to provide accreditation services for suppliers of the specialty code for advanced diagnostic imaging procedures. The accreditation will apply only to the suppliers of the images themselves, not to the physician's interpretation of the image. All accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff. To obtain additional information about the accreditation process, please contact the accreditation organizations listed below.

American College of Radiology (ACR)
1891 Preston White Drive
Reston, VA 20191-4326
1-800-770-0145

Intersocietal Accreditation Commission (IAC)
6021 University Boulevard, Suite 500
Ellicott City, MD 21043
1-800-838-2110

The Joint Commission (TJC)
Ambulatory Care Accreditation Program
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
1-630-792-5286

For the provider education article related to this instruction please click here or copy and paste the following link into your Web browser:  http://www.cms.gov/MLNMattersArticles/downloads/MM7175.pdf

For the official CMS instruction, CR 7175, please click here or copy and paste the following link into your Web browser:  http://www.cms.gov/Transmittals/downloads/R2079CP.pdf