FIRST COAST SERVICE OPTIONS
LOCAL COVERAGE DETERMINATION
CODING GUIDELINES


LCD Number

IDTF

Contractor Name

First Coast Service Options, Inc.

Contractor Number

09102 – Florida
09202 – Puerto Rico
09302 – Virgin Islands

LCD Title

Independent Diagnostic Testing Facility (IDTF)

Coding Guidelines

Desk and Site Reviews

All new IDTF applications shall receive (1) a thorough desk review, and (2) a mandatory site review prior to the carrier’s enrollment of the applicant and issuance of a billing number. The general purpose of both reviews is to determine whether the information listed on Attachment 2 of the CMS-855B is correct, verifiable, and in accordance with IDTF regulatory and manual requirements.

Site Visits for Mobile Units and Electronic Monitoring Services

Mobile units are required to list their geographic service area.  They can be site visited by the following methods:  1) The mobile unit may visit the office of the site reviewer, or 2) The site reviewer can obtain an advance schedule of the locations the IDTF will be visiting and conduct the site visit at one of those locations.

Transtelephonic and electronic monitoring services (e.g., 24-hour ambulatory EKG monitoring; pacemaker monitoring and cardiac event detection) should be classified as IDTFs and must meet all IDTF requirements.  These entities require a supervisory physician who performs general supervision.  Final enrollment of a transtelephonic or electronic monitoring service as an IDTF requires a site visit.

Interpreting Physicians

An Independent Diagnostic Testing Facility (IDTF) is not restricted to billing only the technical component of diagnostic services. In certain situations, an IDTF can bill for both the technical component of the diagnostic test and interpretative services. This approach is referred to as billing “globally”. The interpretative services must be performed by a licensed practitioner who is allowed to perform the service.

If the interpreting practitioner is an employee of the IDTF, the IDTF must submit a Reassignment of Benefits, Form CMS-855R, which has been signed by the practitioner, in accordance with the Medicare Program Integrity Manual (PIM) Chapter 10, sections 4.19 and 7. If the interpreting practitioner is a contractor performing the interpretation on the premises that the IDTF owns or leases, the IDTF must submit a Reassignment of Benefits, Form CMS-855R, which has been signed by the practitioner, in accordance with PIM Chapter 10, sections 41.19 and 7. In no instance may a group of physicians reassign its benefits to the IDTF. Only individual practitioners may reassign their benefits.

When enrolling or updating information, the IDTF shall list all physicians for whose diagnostic test interpretations it will bill. This includes physicians who are providing purchased interpretations to the IDTF (in accordance with CMS Manual System, Pub 100-04, Medicare Claims Processing Manual, Chapter 1, Section 30.2), as well as physicians who are reassigning their benefits to the IDTF. The carrier will ensure and document the following:

·         All physicians listed are enrolled in Medicare.

·         All interpreting physicians who are reassigning their benefits to the IDTF have the right to do so.

·         All required CMS-855R forms have been submitted.

·         The interpreting physicians listed are qualified to interpret the types of tests (codes) listed.  In accordance with this CMS requirement (CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 10, Section 4.19.3), FCSO Medicare requires that the interpreting physician for a test billed by the IDTF meet the same qualification requirements as the supervising physician for that IDTF test as listed in the ‘Credentialing Matrix’.

Note: The applicant cannot bill globally for interpreting physicians not listed.

If an interpreting physician has been recently added or changed, the new interpreting physician must have met all of the interpreting physician requirements at the time any tests were performed.

Off-Site Interpretations

If an IDTF wants to bill for an interpretation performed by an independent practitioner off the premises of the IDTF, it must meet all instructions identified in the CMS Manual System, Pub 100-4, Medical Claims Processing Manual, Chapter 1, concerning purchased interpretations. In this scenario, there is no reassignment of benefits because the purchaser of the test is also considered the supplier of the test.

When the technical component of a test is performed by the IDTF and the interpreting practitioner is the practitioner who ordered the test, the IDTF cannot bill for the interpretation. The interpreting practitioner must bill the interpretation since the IDTF cannot bill the interpretation when the interpreting physician is the referring physician.

Purchased Diagnostic Tests and Jurisdictional Pricing

Services that are reimbursed under the Medicare Physician Fee Schedule (MPFS) are reimbursed by the payment locality where the service is furnished and by the zip code.  Effective for claims received on or after April 1, 2004, carriers must use the zip code of the location where the service was rendered to determine carrier jurisdiction over the claim and the correct payment locality.

When a physician, practitioner, or supplier furnishes services in payment localities that cover more than one carrier’s service area (e.g., the provider has separate offices in multiple localities and/or multiple carriers), separate claims must be submitted to the appropriate carrier for processing.

Effective April 1, 2004, providers may not submit a global billing code on paper or electronic claims when one component of the service has been purchased.  Only one service facility location (name, address and zip code) can be indicated in item 32 on the CMS-1500 form.  Claims received with global services will be returned as unprocessable.

Effective January 25, 2005, suppliers (including laboratories, physicians and independent diagnostic testing facilities [IDTFs]) must bill their local carrier for all purchased diagnostic tests/interpretations, regardless of the location where the purchased service was rendered.

Purchased Technical Components

A physician may bill for the technical component of a diagnostic test that he/she purchased from another physician, medical group or supplier.  However, in order to purchase a diagnostic test from another physician, medical group, or supplier, the purchaser must perform the interpretation (professional component).  Additionally, the physician or supplier that furnished the technical component must be enrolled in the Medicare program.

Purchased Interpretations

A person or entity that provides diagnostic tests may submit the claim, and (if assignment is accepted) receive the Part B payment, for diagnostic test interpretations which that person or entity purchases from an independent physician or medical group if:

·         The tests are initiated by a physician or medical group which is independent of the person or entity providing the tests and of the physician or medical group providing the interpretations;

·         The physician or medical group providing the interpretations does not see the patient; and

·         The purchaser (or employee, partner, or owner of the purchaser) performs the technical component of the test. The interpreting physician must be enrolled in the Medicare program. No formal reassignment is necessary.

·         The purchaser must keep on file the name, the provider identification number and address of the interpreting physician.

Note:  This does not remove the requirement that when an entity either purchases an interpretation or a test, they must perform the other component in order to be paid for the purchased component.  

In order to price claims correctly and apply purchase price limitations, global billing is not acceptable for claims received on the Form CMS-1500 or on the ANSI X12N 837 electronic format. Each component must be billed as a separate line item (or on a separate claim).

Effective for claims with dates of service on or after January 25, 2005, suppliers (including  laboratories, physicians, and IDTFs) must submit claims for all purchased diagnostic tests/interpretations to their local carrier, regardless of the location where the purchased service was furnished.

Credentialing Matrix

CPT/HCPCS
CODES



LEVEL OF PHYSICIAN SUPERVISION



Supervising Physician AND InTERPRETING PHYSICIAN Qualification Requirements


Technician Qualification Requirements



51725

2

Board Certified by the American Board of Medical Specialties (ABMS) Urologist

Urology or OB/GYN Personally Trained Staff

51726

2

Board Certified (ABMS) Urologist

Urology or OB/GYN Personally Trained Staff

51736

2

Board Certified (ABMS) Urologist

Urology or OB/GYN Personally Trained Staff

51741

2

Board Certified (ABMS) Urologist

Urology or OB/GYN Personally Trained Staff

51772

2

Board Certified (ABMS) Urologist

Urology or OB/GYN Personally Trained Staff

51784

2

Board Certified (ABMS) Urologist

Urology or OB/GYN Personally Trained Staff

51785

3

Board Certified (ABMS) Urologist

Urology or OB/GYN Personally Trained Staff

51792

2

Board Certified (ABMS) Urologist

Urology or OB/GYN Personally Trained Staff

51795

2

Board Certified (ABMS) Urologist

Urology or OB/GYN Personally Trained Staff

51797

2

Board Certified (ABMS) Urologist

Urology or OB/GYN Personally Trained Staff

54240

2

Board Certified (ABMS) Urologist

Credentialed by ARDMS: RVT or CCI: RVS

54250

1

Board Certified (ABMS) Urologist

Credentialed by ARDMS: RVT or CCI: RVS

59025

1

Board Certified (ABMS) Obstetrics/Gynecology

Registered Nurse (RN)

70010

3

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70015

3

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70030

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70100

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70110

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70120

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70130

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

70134

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70140

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70150

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70160

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70170

3

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70190

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70200

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70210

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70220

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70240

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70250

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70260

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70300

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70310

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70320

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70328

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70330

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70332

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

70336

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

70350

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

70355

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

70360

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70370

3

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70371

3

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70373

3

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70380

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

70390

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

70450

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70460

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70470

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70480

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70481

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70482

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70486

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70487

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70488

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70490

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70491

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70492

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70496

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70498

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

70540

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

70542

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

70543

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

70544

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

70545

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

70546

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

70547

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

70548

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

70549

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

70551

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

70552

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

70553

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

71010

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71015

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71020

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71021

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71022

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71023

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

71030

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71034

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

71035

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71040

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

71060

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

71100

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71101

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71110

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71111

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71120

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71130

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

71250

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

71260

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

71270

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

71275

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

71550

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

71551

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

71552

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

71555

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72010

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72020

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72040

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72050

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72052

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72069

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72070

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72072

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72074

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72080

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72090

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72100

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72110

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72114

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72120

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72125

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

72126

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

72127

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

72128

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

72129

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

72130

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

72131

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

72132

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

72133

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

72141

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72142

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72146

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72147

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72148

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72149

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72156

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72157

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72158

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72159

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72170

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72190

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72191

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

72192

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

72193

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

72194

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72195

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72196

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72197

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72198

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

72200

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72202

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72220

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72240

3

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72255

3

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72265

3

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72270

3

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72275

3

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist

72285

3

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

72295

3

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

73000

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73010

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73020

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73030

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73040

3

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73050

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73060

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73070

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73080

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73085

3

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73090

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73092

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73100

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73110

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73115

3

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73120

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73130

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73140

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73200

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

73201

2

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

73202

2

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

73206

2

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

73218

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

Credentialed by ARRT: MR or ARMRIT: MRI

73219

2

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

Credentialed by ARRT: MR or ARMRIT: MRI

73220

2

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

Credentialed by ARRT: MR or ARMRIT: MRI

73221

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

Credentialed by ARRT: MR or ARMRIT: MRI

73222

2

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

Credentialed by ARRT: MR or ARMRIT: MRI

73223

2

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

Credentialed by ARRT: MR or ARMRIT: MRI

73225

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

73500

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73510

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73520

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73525

3

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73530

3

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73540

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73542

3

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73550

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73560

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73562

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73564

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73565

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73580

3

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73590

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73592

1

Board Certified (ABMS) Radiologist or Orthopaedic Surgeon

 State License: General Radiographer or Medical Physicist

73600

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73610

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73615

3

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73620

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73630

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73650

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73660

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

 State License: General Radiographer or Medical Physicist

73700

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

73701

2

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

73702

2

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

73706

2

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

73718

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

73719

2

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

73720

2

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

73721

1

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

73722

2

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

73723

2

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

73725

2

Board Certified (ABMS) Radiologist, Orthopaedic Surgeon or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

74000

1

Board Certified (ABMS) Radiologist or Urologist

 State License: General Radiographer or Medical Physicist

74010

1

Board Certified (ABMS) Radiologist or Urologist

 State License: General Radiographer or Medical Physicist

74020

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

74022

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

74150

1

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

74160

2

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

74170

2

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

74175

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

74181

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

74182

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

74183

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

74185

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

74190

3

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

74210

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74220

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74230

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74240

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74241

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74245

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74246

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74247

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74249

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74250

2

Board Certified (ABMS) Radiologist

State License: General Radiographer

74251

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74260

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74270

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74280

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74283

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74290

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

74291

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

74300

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74301

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74305

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74320

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74327

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74328

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74329

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74330

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

74400

2

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer

74410

2

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer

74415

2

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer

74420

3

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer

74425

3

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer

74430

3

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer

74440

3

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer

74445

3

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer

74450

3

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer

74455

3

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer

74470

3

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer

74710

1

Board Certified (ABMS) Radiologist or Urologist

 State License: General Radiographer or Medical Physicist

74740

3

Board Certified (ABMS) Radiologist or Gynocologist

 State License: General Radiographer or Medical Physicist

74742

3

Board Certified (ABMS) Radiologist or Gynocologist

 State License: General Radiographer or Medical Physicist

74775

3

Board Certified (ABMS) Radiologist or Gynocologist

State License: General Radiographer

75557

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

75559

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

75561

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

75563

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

75600

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75605

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75625

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75630

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75635

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

75650

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75658

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75660

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75662

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75665

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75671

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75676

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75680

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75685

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75705

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75710

3

Board Certified (ABMS) Radiologist, Cardiologist or Vascular Surgeon

State License: General Radiographer

75716

3

Board Certified (ABMS) Radiologist, Cardiologist or Vascular Surgeon

State License: General Radiographer

75722

3

Board Certified (ABMS) Radiologist, Cardiologist or Vascular Surgeon

State License: General Radiographer

75724

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75726

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75731

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75733

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75736

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75741

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75743

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75746

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75756

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75774

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75790

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75801

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

75803

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

75805

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

75807

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

75809

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

75810

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75820

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75822

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75825

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75827

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75831

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75833

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75840

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75842

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75860

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75870

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75872

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75880

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75885

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75887

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75889

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

75891

3

Board Certified (ABMS) Radiologist or Vascular Surgeon

State License: General Radiographer

76000

3

Board Certified (ABMS) Radiologist or Urologist or in the field related to the Primary Procedure

State License: General Radiographer

76001

3

Board Certified (ABMS) Radiologist or Urologist or in the field related to the Primary Procedure

State License: General Radiographer

76010

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

76080

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

76098

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

76100

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

76101

2

Board Certified (ABMS) Radiologist

State License: General Radiographer

76102

2

Board Certified (ABMS) Radiologist

State License: General Radiographer

76120

2

Board Certified (ABMS) Radiologist

State License: General Radiographer

76125

2

Board Certified (ABMS) Radiologist

State License: General Radiographer

76150

1

Board Certified (ABMS) Radiologist

State License: General Radiographer

76350

2

Board Certified (ABMS) Radiologist

State License: General Radiographer

76376

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

76377

3

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

76380

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

76390

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

76506

1

Board Certified (ABMS) Radiologist or Neurologist

Credentialed by ARDMS: RDMS-NE or ARRT:R.T.-S

76510

2

Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist

Credentialed by ARDMS: RDMS-OP or JCAHPO: COT or COMT

76511

2

Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist

Credentialed by ARDMS: RDMS-OP or JCAHPO: COT or COMT

76512

2

Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist

Credentialed by ARDMS: RDMS-OP or JCAHPO: COT or COMT

76513

2

Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist

Credentialed by ARDMS: RDMS-OP or JCAHPO: COT or COMT

76514

1

Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist

Credentialed by ARDMS: RDMS-OP or JCAHPO: COT or COMT

76516

1

Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist

Credentialed by ARDMS: ROUB or RDMS-OP or JCAHPO: COT or COMT

76519

1

Board Certified (ABMS) Opthalmologist, Radiologist or Optometrist

Credentialed by ARDMS: ROUB or RDMS-OP or JCAHPO: COT or COMT

76529

1

Board Certified (ABMS) Opthalmologist or Radiologist

Credentialed by ARDMS: ROUB or RDMS-OP or JCAHPO: COT or COMT

76536

1

Board Certified (ABMS) Radiologist or Neurologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76604

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS or ARRT:R.T.-S

76645

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-BS

76700

1

Board Certified (ABMS) Radiologist or Urologist

Credentialed by ARDMS RDMS or ARRT: R.T.-S

76705

1

Board Certified (ABMS) Radiologist or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76770

1

Board Certified (ABMS) Radiologist or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76775

1

Board Certified (ABMS) Radiologist or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76776

1

Board Certified (ABMS) Radiologist or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76801

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76802

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76805

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76810

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76811

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76812

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76813

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76814

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76815

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76816

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76817

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76818

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76819

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76820

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76821

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76825

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76826

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76827

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76828

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76830

1

Board Certified (ABMS) Radiologist or Urologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76831

3

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76856

1

Board Certified (ABMS) Radiologist or Urologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76857

1

Board Certified (ABMS) Radiologist or Urologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T.-S

76870

1

Board Certified (ABMS) Radiologist or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76872

1

Board Certified (ABMS) Radiologist or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76873

2

Board Certified (ABMS) Radiologist or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76880

1

Board Certified (ABMS) Radiologist or Podiatrist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76885

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76886

1

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS or ARRT: R.T.-S

76942

3

Board Certified (ABMS) Radiologist , Podiatrist, or Urologist

Credentialed by ARDMS: RDMS or ARRT: R.T. - S

76946

3

Board Certified (ABMS) Radiologist

Credentialed by ARDMS: RDMS-OB/GYN or ARRT: R.T. - S

76970

1

Board Certified (ABMS) Radiologist or Urologist

Credendentialed by ARDMS: RDMS or ARRT:R.T.-S

76975

3

Board Certified (ABMS) Radiologist

Credendentialed by ARDMS: RDMS or ARRT:R.T.-S

76977

1

Board Certified (ABMS) Radiologist , Podiatrist, or Urologist

Credendentialed by ARDMS: RDMS or ARRT:R.T.-S or- BD

77002

3

Board Certified (ABMS) Radiologist or in the field related to the Primary Procedure

State License: General Radiographer

77003

3

Board Certified (ABMS) Radiologist or in the field related to the Primary Procedure

State License: General Radiographer

77012

3

Board Certified (ABMS) Radiologist , Podiatrist, or Urologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

77014

2

Board Certified (ABMS) Radiologist

State License: General Radiographer or Medical Physicist and ARRT: R.T.-CT

77021

3

Board Certified (ABMS) Radiologist or Podiatrist

Credentialed by ARRT: MR or ARMRIT: MRI

77031

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

77032

3

Board Certified (ABMS) Radiologist

State License: General Radiographer

77051

1

Board Certified (ABMS) Radiologist

State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography

77052

1

Board Certified (ABMS) Radiologist

State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography

77053

3

Board Certified (ABMS) Radiologist

State License: General Radiographer and ARRT: R.T.-M

77054

3

Board Certified (ABMS) Radiologist

State License: General Radiographer and ARRT: R.T.-M

77055

1

Board Certified (ABMS) Radiologist

State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography

77056

1

Board Certified (ABMS) Radiologist

State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography

77057

1

Board Certified (ABMS) Radiologist

State License: General Radiographer and ARRT: R.T.-M and Facility Must be FDA Certified to Perform Mammography

77058

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

77059

2

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

77071

3

Board Certified (ABMS) Radiologist or Podiatrist

Physician Service Code - Must be performed by a physician

77072

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

77073

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

77074

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

77075

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

77076

1

Board Certified (ABMS) Radiologist

 State License: General Radiographer or Medical Physicist

77077

1

Board Certified (ABMS) Radiologist or Podiatrist

 State License: General Radiographer or Medical Physicist

77078

1

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer and ARRT: R.T.-CT

77079

1

Board Certified (ABMS) Radiologist or Urologist

State License: General Radiographer and ARRT: R.T.-CT

77080

1

Board Certified (ABMS) Radiologist, Internal Medicine Specialist, or Urologist

State License: General Radiographer and ARRT: R.T.-BD

77081

1

Board Certified (ABMS) Radiologist, Internal Medicine Specialist, or Urologist

State License: General Radiographer and ARRT: R.T.-BD

77082

1

Board Certified (ABMS) Radiologist or Internal Medicine Specialist

State License: General Radiographer and ARRT: R.T.-BD

77083

1

Board Certified (ABMS) Radiologist or Internal Medicine Specialist

State License: General Radiographer and ARRT: R.T.-BD

77084

1

Board Certified (ABMS) Radiologist

Credentialed by ARRT: MR or ARMRIT: MRI

77417

1

Board Certified (ABMS) Radiologist

State License: General Radiographer or medical physicist

78000

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78001

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78003

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78006

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78007

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78010

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78011

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78015

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78016

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78018

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78020

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78070

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78075

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78102

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78103

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78104

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78110

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78111

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78120

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78121

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78122

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78130

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78135

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78140

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78185

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78190

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78191

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78195

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78201

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78202

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78205

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78206

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78215

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78216

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78220

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78223

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78230

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78231

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78232

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78258

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78261

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78262

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78264

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78267

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78268

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78270

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78271

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78272

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78278

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78282

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78290

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78291

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78300

1

Board Certified (ABMS) Nuclear Medicine, Radiology or Podiatrist

ARRT: N or NMTCB: CNMT

78305

1

Board Certified (ABMS) Nuclear Medicine, Radiology or Podiatrist

ARRT: N or NMTCB: CNMT

78306

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78315

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78320

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78350

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78414

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78428

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78445

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78456

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78457

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78458

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78459

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78460

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78461

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78464

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78465

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78466

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78468

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78469

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78472

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78473

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78478

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78480

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78481

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78483

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78491

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78492

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78494

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78496

1

Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

ARRT: N or NMTCB: CNMT

78580

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78584

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78585

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78586

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78587

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78588

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78591

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78593

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78594

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78596

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78600

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78601

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78605

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78606

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78607

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78608

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78610

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78630

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78635

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78645

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78647

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78650

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78660

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78700

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78701

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78707

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78708

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78709

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78710

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78725

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78730

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78740

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78761

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78800

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78801

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78802

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78803

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78804

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78805

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78806

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78807

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78811

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78812

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78813

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78814

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78815

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

78816

1

Board Certified (ABMS) Nuclear Medicine or Radiology

ARRT: N or NMTCB: CNMT

91000

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91010

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91011

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91012

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91020

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91022

2

Board certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91030

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91034

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91035

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91037

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91038

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91040

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91052

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91055

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91065

2

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91120

2

Board Certified (ABMS) Gastroenterologist Colorectal Surgeon

Registered Nurse (RN)

91122

2

Board Certified (ABMS) Gastroenterologist Colorectal Surgeon

Registered Nurse (RN)

91132

3

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

91133

3

Board Certified (ABMS) Gastroenterologist

Registered Nurse (RN)

92060

1

Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist

Credentialed by JCAHPO: COT or COMT

92081

1

Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist

Credentialed by JCAHPO: COT or COMT

92082

1

Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist

Credentialed by JCAHPO: COT or COMT

92083

1

Board Certified (ABMS) Ophthalmologist, Neurologist or Optometrist

Credentialed by JCAHPO: COT or COMT

92100

9

Board Certified (ABMS) Ophthalmologist or Optometrist/Physician Supervision concept does not apply

Physician Service Code - Must be performed by a physician

92120

9

Board Certified (ABMS) Ophthalmologist or Optometrist/Physician Supervision concept does not apply

Physician Service Code - Must be performed by a physician

92130

9

Board Certified (ABMS) Ophthalmologist or Optometrist/Physician Supervision concept does not apply

Physician Service Code - Must be performed by a physician

92135

1

Board Certified (ABMS) Ophthalmologist or Optometrist

Credendentialed by JCAHPO: COT or COMT

92136

1

Board Certified (ABMS) Ophthalmologist or Optometrist

Credentialed by JCAHPO: COT or COMT

92235