Definitions

The following terms used in 130 CMR 431.000 have the meanings given in 130 CMR 431.402 unless the context clearly requires a different meaning. The reimbursability of services described in 130 CMR 431.000 is not determined by these definitions, but by the application of regulations elsewhere in 130 CMR 431.000 and 450.000: Administrative and Billing Regulations. Direct Supervision — the physician is present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not require that the physician be present in the room when the procedure is performed. General Supervision — the procedure is furnished under the physician’s overall direction and control, but the physician is not necessarily required during the performance of the procedure. Independent Diagnostic Testing Facility (IDTF) — a Medicare–certified diagnostic imaging center, freestanding magnetic resonance imaging (MRI) center, portable X-ray provider, sleep center, or mammography van, in a fixed location or mobile entity, that is physically and financially independent of a hospital or physician’s office, and performs diagnostic tests. These tests must be performed by a physician or by licensed, certified nonphysician personnel under appropriate physician supervision and comply with the applicable laws of any state in which it operates. Interpreting Physician — a physician who determines the meaning of test results provided by the IDTF, either on the IDTF premises or at a remote location. Mobile IDTF — a facility that takes its equipment to a location other than its own office. The equipment may be small enough to load and unload from a van as with some sonography or PFT equipment; or it may be fixed in the vehicle such as a mobile MRI unit. Nonphysician Personnel — technicians, employed or contracted by the IDTF, whose function is to perform the technical component of a given diagnostic test. Personal Supervision — a physician is physically in the room during the performance of the procedure. Referring Physician — a physician who requests or orders the service but does not necessarily perform the service. Supervising Physician — a physician responsible for the personal, direct, or general supervision of the testing performed, the quality of the testing performed, the proper operation and calibration of the equipment used to perform tests, and the actions of nonphysician personnel who use the equipment. Treating Clinician — a physician (as defined in 42 U.S.C. 1395x(r)) or nurse practitioner, clinical nurse specialist, or physician assistant (as defined in 42 U.S.C. 1395x(s)(2)(K)) who furnishes a consultation or treats a member for a specific medical problem, and who uses the result of a diagnostic test in the management of the member’s specific medical problem.