Sunday, August 29, 2010

Payments for Radionuclides, IV Persantine,Adenosine

Nuclear Medicine (Procedure code 78000 - 79999)

Payments for Radionuclides

The TC RVUs for nuclear medicine procedures (Procedure codes 78XXX for diagnostic nuclear medicine, and codes 79XXX for therapeutic nuclear medicine) do not include the radionuclide used in connection with the procedure. These substances are separately billed under codes A4641 and A4642 for diagnostic procedures, and code 79900 for therapeutic procedures and are paid on a “By Report” basis depending on the substance used. In addition, Procedure code 79900 is separately payable in connection with certain clinical brachytherapy procedures. (See §70.4 for brachytherapy procedures).

Stressing Agent

Carriers must make separate payment under code J1245 for pharmacologic stressing agents used in connection with nuclear medicine and cardiovascular stress testing procedures furnished to beneficiaries in settings in which TCs are payable. Such an agent is classified as a supply and covered as an integral part of the diagnostic test. However, carriers pay for code J1245 under the policy for determining payments for “incident to” drugs. See Chapter 17 for payment for drugs.

FI Payment for IV Persantine

The FIs pay drug IV Persantine based on the drug pricing methodology when used in conjunction with nuclear medicine and cardiovascular stress testing procedures furnished to SNF outpatients. Separate drug pricing methodology payments for IV Persantine is made in addition to payments made for the procedure. SNFs bill HCPCS code J1245 (injection, dipyridamole, per 10 mg.) with revenue code 0636.

FI Payment for Adenosine

The drug adenosine is paid based on the drug payment methodology when used as a pharmacologic stressor for other diagnostic testing. Separate based payment for adenosine will be made in addition to payments made for the procedure for SNF Part B patients. When billing for adenosine, HCPCS code J0150 (Injection, adenosine, 6 mg.) should be reported with revenue code 0636.

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