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Part       DIAGNOSTIC TESTING ENTITIES

317:30⊂chapter=5∂=90--907.Eligible providers
[Revised 09-01-16]

(a) An Independent Diagnostic Testing Facility (IDTF) is either a fixed location or mobile entity independent of a hospital or physician's office where diagnostic services are performed by licensed certified non-physician personnel under appropriate physician supervision. Diagnostic testing entities must be Medicare certified as Mobile X-ray or an IDTF and have a current contract on file with the Oklahoma Health Care Authority.

(b) An IDTF must have one or more supervising physicians who are responsible for the direct and ongoing oversight of the quality of the testing performed, the proper operation and calibration of the equipment used to perform tests and the qualifications of non-physician personnel who use the equipment.

(c) An IDTF enrolled in the SoonerCare program must comply with all applicable federal regulations, including applicable provisions of 42 CFR 410.32 and 42 CFR 410.33.


317:30⊂chapter=5∂=90--907.1.Coverage and limitations
[Revised 09-01-16]

(a) Adults. For IDTF services to be covered:

(1) Services must be medically necessary;

(2) The treating physician's order must specify the procedures to be performed and the reason for the service; and

(3) The IDTF may not add any procedures based on internal protocols without a written order by the treating physician.

(b) Children. Coverage is the same as adults.



317:30⊂chapter=5∂=90--907.2.Individuals eligible for Part B of Medicare
[Issued 10-06-04]
Payment is made utilizing the Medicaid allowable for comparable services.

317:30⊂chapter=5∂=90--907.3.Reimbursement
[Revised 09-01-16]

(a) Diagnostic procedure are reimbursable if the services were rendered to a non-hospital patient and the IDTF provided all services (professional and technical) associated with the total procedure as defined in the CPT. When separate CPT codes itemize a service by its professional and technical components, the IDTF may bill and be reimbursed for the components of the procedure it actually performed.

(b) Payment is made for the technical component on outpatient diagnostic procedures in accordance with the guidelines set forth in OAC 317:30-5-24.



Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.