States Applicable to Alert: Northern and Southern California, Nevada, Hawaii, Guam, American Samoa and Northern Mariana Islands.

Background Information: The Independent Diagnostic Testing Facility (IDTF) Local Coverage Determination (LCD) was retired, as there were CPT codes listed in the LCD that were not diagnostic services or were inappropriate for an IDTF.

A table listing the procedure codes that may be performed in an IDTF, qualifications needed for professionals and nonprofessionals, level of physician supervision required when performing the test and any modifiers applicable to the CPT codes was placed in the Provider Enrollment IDTF table on the Palmetto GBA Web site.

Previously allowed services that were removed from the covered table are now denying for dates of service prior to April 18, 2009. Please see list of relevant codes below.

Applies to procedure codes:

Procedure Codes
54230	70559	74360	75940	75994	76940	77051
54231	71090	74363	75961	75995	76941	77053
58340	72275	74475	75962	75996	76942	77054
59020	73530	74480	75964	76370	76945	77055
62270	74235	74485	75966	76496	76946	77056
62284	74300	75552	75968	76497	76948	77071
62290	74301	75553	75970	76498	76975	78099
62291	74305	75554	75978	76499	76999	78199
62310	74320	75555	75980	76813	77011	78299
62311	74327	75556	75982	76814	77012	78350
62318	74328	75894	75984	76930	77014	78399
62319	74329	75896	75989	76932	77021	78499
70557	74330	75898	75992	76936	77031	78599
70558	74340	75900	75993	76937	77032	78615

Procedure Codes
78699	93722	94014	95868	96120	G0106
78799	93727	94015	95869	0067T	G0130
78999	93731	94016	95870	0068T	G0366
91299	93732	94799	95872	0069T	G0367
92065	93733	95199	95873	0104T	G0368
92596	93734	95806	95874	0105T	G0389
92620	93735	95824	95875	0159T	Q0035
92621	93736	95860	95920	0174T
92625	93740	95861	95928	0175T
92626	93784	95863	95929	0178T
92627	93786	95864	95955	0179T
92640	93788	95865	95961	0180T
93233	93790	95866	95962	0181T
93660	93799	95867	96119	0187T

Modifier(s): N/A

Remark /Reason Codes:
B7: This provider was not certified/eligible to be paid for this procedure/service on this date of service.

MAC Action: The system is being updated to allow the above services for dates of service prior to April 18, 2009. A mass adjustment will be performed once the system is updated.

A mass adjustment was completed on August 24, 2009, with 619 claims adjusted in Southern California, 259 claims in Northern California and 28 claims in Hawaii and Nevada.

Provider Action: None

Date Reported: May 27, 2009
Date Resolved: August 24, 2009