CMS Pub. 100-02, ch. 15, § 80.6.3

If the testing facility cannot reach the treating physician/practitioner to change the order or obtain a new

order and documents this in the medical record, then the testing facility may furnish the additional

diagnostic test if all of the following criteria apply:

• The testing center performs the diagnostic test ordered by the treating physician/practitioner;

• The interpreting physician at the testing facility determines and documents that, because of the

abnormal result of the diagnostic test performed, an additional diagnostic test is medically necessary;

• Delaying the performance of the additional diagnostic test would have an adverse effect on the care

of the beneficiary;

• The result of the test is communicated to and is used by the treating physician/practitioner in the

treatment of the beneficiary; and

• The interpreting physician at the testing facility documents in his/her report why additional testing

was done.

EXAMPLE:

The last cut of an abdominal CT scan with contrast shows a mass requiring a pelvic CT scan to further

delineate the mass; (b) a bone scan reveals a lesion on the femur requiring plain films to make a diagnosis.