Page 116 - Medicare Benefit Policy Manual

Treating Physician

A “treating physician” is a physician, as defined in §1861(r) of the Social Security Act
(the Act), who furnishes a consultation or treats a beneficiary for a specific medical
problem, and who uses the results of a diagnostic test in the management of the
beneficiary’s specific medical problem.

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.

Treating Practitioner

A “treating practitioner” is a nurse practitioner, clinical nurse specialist, or physician
assistant, as defined in §1861(s)(2)(K) of the Act, who furnishes, pursuant to State law, a
consultation or treats a beneficiary for a specific medical problem, and who uses the
result of a diagnostic test in the management of the beneficiary’s specific medical
problem.

Testing Facility

A “testing facility” is a Medicare provider or supplier that furnishes diagnostic tests. A
testing facility may include a physician or a group of physicians (e.g., radiologist,
pathologist), a laboratory, or an independent diagnostic testing facility (IDTF).

Order

An “order” is a communication from the treating physician/practitioner requesting that a
diagnostic test be performed for a beneficiary. The order may conditionally request an
additional diagnostic test for a particular beneficiary if the result of the initial diagnostic
test ordered yields to a certain value determined by the treating physician/practitioner
(e.g., if test X is negative, then perform test Y). An order may be delivered via the
following forms of communication:

• A written document signed by the treating physician/practitioner, which is hand-
delivered, mailed, or faxed to the testing facility; NOTE: No signature is
required on orders for clinical diagnostic tests paid on the basis of the clinical
laboratory fee schedule, the physician fee schedule, or for physician pathology
services;

• A telephone call by the treating physician/practitioner or his/her office to the
testing facility; and

• An electronic mail by the treating physician/practitioner or his/her office to the
testing facility.