Providers billing for Procedure-4 radiology codes 78110, 78111, 78120 – 78122, 78130, 78191 and 78270 – 78272 must be Clinical Laboratory Improvement Amendments (CLIA)-certified. Laboratories that do not perform proficiency testing verification for Radiobioassay must have a system for verifying the accuracy and reliability of test results at least twice per year. Questions regarding state and federal requirements for proficiency testing should be directed to the California Department of Public Health (CDPH) Laboratory Field Services at (510) 620-3800.
Rendering Provider Number
The rendering provider number is required on claims for services billed with Procedure-4 codes 70010 – 79999. However, the provider number of the attending/referring/prescribing physician, if different from the rendering provider, continues to be required on the claim for these procedures.
Radiologists requesting reimbursement for procedures outside these code ranges must meet the rendering provider number requirements.