Other Medicare Part B Services

10.2.4 - Other Medicare Part B Services (Rev. 13355; Issued: 08-13-25; Effective: 05-05-25; Implementation: 05-05-25) A. Residents and Interns 1. General Background Information If the applicant is a "resident" in an "approved medical residency program" (as these two terms are defined at 42 CFR § 413.75(b)), the contractor shall refer to Pub. 100-02, chapter 15, section 30.3 for further instructions. (The contractor can also refer to 42 CFR § 415.200, which states that services furnished by residents in approved programs are not "physician services.”) The physician should indicate the exact date on which its residency program, internship, or fellowship was completed, so that the appropriate effective date can be issued. 2. Interns are Ineligible to Enroll in the Medicare Program An intern cannot enroll in the Medicare program. (For purposes of this requirement, the term “intern” means an individual who is not licensed by the state because the person is still in post- graduate year (PGY) 1.) B. Diabetes Self-Management Training Diabetes self-management training (DSMT) is not a separately recognized provider type, such as a physician or nurse practitioner. A person or entity cannot enroll in Medicare for the sole purpose of performing DSMT. Rather, DSMT is an extra service that an enrolled provider or supplier can bill for, assuming it meets all of the necessary DSMT requirements. If the person or entity enrolls as a provider type (i.e., pharmacy, mass immunizer) that requires the submission of an application fee, the fee shall be submitted with the application. All DSMT programs must be accredited as meeting quality standards by a CMS-approved national accreditation organization. CMS recognizes the American Diabetes Association (ADA) and the Association of Diabetes Care & Education Specialists (ADCES) (formerly known as the American Association of Diabetes Educators or AADE) as approved national accreditation organizations. A Medicare-enrolled provider or non-DMEPOS supplier that wishes to bill for DSMT may simply submit the appropriate accreditation certificate to its contractor. No Form CMS-855 is required unless the provider or supplier is not in the Provider Enrollment, Chain and Ownership System (PECOS), in which case a complete Form CMS-855 application must be submitted. If the supplier is exclusively a DMEPOS supplier, it must complete and submit a Form CMS- 855B application to its local Part A/B MAC. This is because A/B MACs, rather than Durable Medical Equipment Medicare Administrative Contractors, pay DSMT claims. Thus, the DMEPOS supplier must separately enroll with its A/B MAC even if it has already completed a Form CMS-855S. If an A/B MAC receives an application from a DMEPOS supplier that would like to bill for DMST, it shall verify with the applicable NPE contractor that the applicant is currently enrolled and eligible to bill the Medicare program. For more information on DSMT, refer to: • 42 CFR Part 410 (subpart H) • Publication 100-02, Medicare Benefit Policy Manual, chapter 15, sections 300 – 300.5.1 C. Mass Immunizers Who Roster Bill An entity or individual who wishes to furnish mass immunization services - but may not otherwise qualify as a Medicare provider - may be eligible to enroll as a “Mass Immunizer” via the Form CMS-855I (individuals) or the Form CMS-855B (entities). Such suppliers must meet the following requirements: 1. They may not bill Medicare for any services other than pneumococcal pneumonia vaccines (PPVs), influenza virus vaccines, and their administration. 2. They must submit claims through the roster billing process. 3. The supplier, as well as all personnel who administer the shots, must meet all applicable state and local licensure or certification requirements. The roster billing process was developed to enable Medicare beneficiaries to participate in mass PPV and influenza virus vaccination programs offered by public health clinics and other organizations. In addition: • See 42 CFR §§ 424.520(d) and 424.521(a) for information regarding mass immunizer effective dates. • In Section 4 of the Form CMS-855, the supplier need not list each off-site location (e.g., county fair, shopping mall) at which it furnishes services. It need only list its base of operations (e.g., county health department headquarters, drug store location). For more information on mass immunization roster billing, refer to: • Publication 100-02, Benefit Policy Manual, chapter 15, section 50.4.4.2 • Publication 100-04, Claims Processing Manual, chapter 18, sections 10 through 10.3.2.3 D. Advanced Diagnostic Imaging Section 135(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) amended section 1834(e) of the Social Security Act. It required the Secretary to designate organizations to accredit suppliers – including, but not limited to, physicians, non-physician practitioners, and independent diagnostic testing facilities - that furnish the technical component (TC) of advanced diagnostic imaging services. MIPPA specifically defined advanced diagnostic imaging procedures as including diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging, such as positron emission tomography (PET). The law also authorizes the Secretary to specify other diagnostic imaging services in consultation with physician specialty organizations and other stakeholders. The CMS has approved four national accreditation organizations (AOs) – the American College of Radiology, the Inter-societal Accreditation Commission, the Joint Commission, and Rad Site - to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures. The accreditation applies only to: (1) the suppliers of the images, not to the physician's interpretation of the image; and (2) those who are paid under the Physician Fee Schedule. All AOs have quality standards that address the safety of the equipment as well as the safety of the patients and staff. Each of these designated AOs submits monthly reports to CMS that list the suppliers who have been or are accredited, as well as the beginning and end-dates of the accreditation and the respective modalities for which they receive accreditation. Newly enrolling physicians and non-physician practitioners described above do not need to complete the appropriate boxes for Advanced Diagnostic Imaging (ADI) on Internet-based PECOS or the appropriate Form CMS-855. Information for all ADI accredited suppliers is provided to CMS by the approved ADI AOs. The contractor need not verify ADI information submitted on the application.