IR Quarterly

Authors: Paul W. Pitts Thomas W. Greeson

Medicare Part B covers and pays for the services of physicians and certain other health care practitioners provided to beneficiaries aged 65 and older. Like any government program, these benefits have specific limitations. A limitation that is important to interventional radiologists concerns whether a particular procedure must be performed by a licensed physician, rather than a nonphysician practitioner. IRs are well served to learn and follow these Medicare rules in order to avoid costly overpayments and refunds.

In a hospital setting, nondiagnostic procedures typically performed by IRs (non-70000 CPT codes) must be performed by a physician. A physician submits claims for reimbursement for these federal programs on Form CMS-1500. Section 24J of the Form CMS-1500 requires the “rendering provider id#.” Definitions that accompany the Form CMS-1500 indicate that the rendering provider is the individual who provided the care and that the “Rendering Provider does not include individuals performing services in support roles, such as lab technicians or radiology technicians.”

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