Friday, March 26, 2021

Nerd Note: Finding Out if an IDTF is Enrolled in Medicare

Medicare has a unique type of provider (created by regulation not statute) called IDTF - Independent Diagnostic Testing Facility.

For example, this is how iRhythm is enrolled as a Medicare medical provider, as an "IDTF."  


One of the most innovative providers in cardiology imaging is HeartFlow, which provides sophisticated computed fractional flow reserve based on prior high resolution cardiac CT imaging.  Website here.

As a cutting-edge innovator, Heartflow faced a series of problems with CMS that are a matter of public  record.  

  • For example, they experienced denials when attempting to enroll (here 2016, here 2017).*  
  • Later, when Heartflow got a CPT code (Category III), I recall that CMS initially wanted to categorize it as "bundled" (ouch!!!).  
    • But with some good arguments, CMS later recognized Heartflow analysis as separately payable, and assigned it a substantial hospital outpatient APC payment level (I think around $1500).

I noticed that Noridian has a brand new pending LCD for HeartFlow which will be effective in April (L36615, A58097).   Seeing those LCDs, it led me to as, Is HearFlow enrolled as an IDTF now?

Is Heartflow Enrolled as an IDTF now?

Start by finding the NPI Number

First, it's really easy to lookup an NPI number - you can google Heartflow and NPI, or go to a database

The NPI for Heartflow is 1982019980.

What Doesn't Work

There's a CMS Physician Compare database that lets you look up whether a physician NPI is enrolled in Medicare, or a hospice,  but this dataset doesn't include IDTF as a category to look up within.

What Did Work

Support staff at Noridian pointed me to a public database called MEDPARD that gives LOTS of types of providers, many more than the prior link.  Use this Noridian link:

Here, the drop down menu gives you all the physician specialties (hematologist, internal medicine, endocrinology), plus a plethora of institutional categories (hospital, hospice), plus... IDTF.

Select IDTF and select Northern California, and you get a list of 200 IDTFs, one of which is HeartFlow.  



Misnamed?  MEDPARD is "Medicare Participating Physician Directory," but as just indicated, it seems to be misnamed, in as much as it displays a large variety of provider types besides physicians.  

Other MACs, Different Windows to MEDPARD.  I may have been lucky with the Noridian webpage into MEDPARD; I tried to search the MEDPARD database at the NGS MAC for any IDTFs in Illinois and got "0" which seems unlikely.   

I tried Novitas for Texas, but it required a county to be named in Texas, before initiating its Medpard search, and when I picked one by chance, it gave an error message.


* Based on information I got via FOIA, these enrollment challenges between HeartFlow and Noridian continued past 2017 into 2018 or 2019.