Can a radiologist order additional tests if medically necessary as long as they document the medical necessity and write an order?
It is our interpretation that an order for additional tests can be given only by the treating physician. NOTE: A radiologist performing a therapeutic interventional procedure is considered a treating physician. A radiologist performing a diagnostic interventional or diagnostic procedure is not considered a treating physician.) The specific regulatory language from the Code of Federal Regulations (42 CFR 410.32(a)) states as follows: All diagnostic X-ray tests, diagnostic laboratory tests, and other diagnostic tests must be ordered by the physician who is treating the beneficiary, that is, the physician who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary’s specific medical problem. Tests not ordered by the physician who is treating the beneficiary are not reasonable and necessary. CMS does allow for the following exception for screening mammograms (see CMS Publication100-4, the Medicare Claims
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