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Independent Diagnostic Testing Facilities (IDTF's) Require Prior Approval

In February 2007, BCBSNC implemented its Diagnostic Imaging Management program. As you know, certain outpatient, high-tech diagnostic imaging procedures are subject to prior approval under this program. This includes outpatient diagnostic care performed in such locations as a physician's office, outpatient department of a hospital or freestanding imaging center. BCBSNC would like to clarify that this also includes facilities and/or clinics filing as independent diagnostic testing facilities (IDTFs). It is possible that some claims previously filed using this place of service may have been reimbursed without pre-certification; however, it is BCBSNC's intent to include IDTFs in its Diagnostic Imaging Management program. As of January 1, 2010, BCBSNC will ensure that no claims filed as IDTF will be reimbursed without proper pre-certification. Denials for these services are not billable to BCBSNC members.

If you have questions, please contact your local Network Management representative.