Monday, August 9, 2010

Computerized Axial Tomography (CT) Procedures - Q9945,Q9951

Carriers do not reduce or deny payment for medically necessary multiple CT scans of different areas of the body that are performed on the same day.

The TC RVUs for CT procedures that specify “with contrast” include payment for high osmolar contrast media. When separate payment is made for low osmolar contrast media under the conditions set forth in §30.1.1, reduce payment for the contrast media as set forth in §30.1.2.

Low Osmolar Contrast Media (LOCM) (HCPCS Codes Q9945-Q9951)

HCPCS codes A4644-A4646 have been replaced with Q9945-Q0051


Payment Criteria

Carriers make separate payments for LOCM (HCPCS codes Q9945-Q9951) in the case of all medically necessary intrathecal radiologic procedures furnished to nonhospital patients. Effective January 1, 2005 in the case of intraarterial and intravenous radiologic procedures, the five restrictive criteria (a history of previous adverse reaction to contrast material, with the exception of a sensation of heat, flushing, or a single episode of nausea or vomiting; a history of asthma or allergy; significant cardiac dysfunction including recent or imminent cardiac decompensation, severe arrhythmia, unstable angina pectoris, recent myocardial infarction, and pulmonary hypertension; generalized severe debilitation; or sickle cell disease) for the payment of LOCM are eliminated.

Payment Level

Determine payment in the same manner as for a drug furnished incident to a physician’s service.
The payment methodology for LOCM for the period of January 1, 2005 through March 31, 2005 is made in accordance with the established payment for calendar year 2004 using codes A4644-A4646.

Effective April 1, 2005, the method of payment for LOCM is the average sales price (ASP) plus six percent in accordance with the standard methodology for drug pricing established by the Medicare Modernization Act (MMA0 for other than hospital outpatient claims. Payments for the new Q codes can be found in the respective quarterly Medicare Part B drug pricing files that are posted on the CMS Web site.

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