Friday, February 18, 2011

Radioelements billing - Procedure code Q3001

Radioelements

In all cases, the radioisotope must be billed by the provider licensed and trained in nuclear
materials use. The date of service for the radioelement claim must match the date of service
for the procedure performed.

1. The expendable source Q3001 is only reimbursed when billed in an office or free-standing
radiological facility (11), independent clinic (49).

For electronic billing in item 19 narrative, list iodine (I-125); palladium (Pd-103); and
cesium (Cs-131), the number of seeds ordered, invoice price and the number of seeds used
in the procedure. It is recognized that a small number of additional seeds is ordered and
billed to cover plan changes or intra-operative loss.

2. In the OPPS setting use the source specific C code that best describes the radioelement
should be used and it is priced off the OPPS fee schedule. Note that when billing for
stranded sources, providers should bill the number of units of the appropriate source
HCPCS C-code according to the number of brachytherapy sources in the strand, and
should not bill as one unit per strand.

3. In the ASC (24) setting, effective 01/01/2008, use the source specific C code that best
describes the radioelement should be used. Prior to 01/01/2008 Code Q3001 was used in
the ASC.

Payment for Brachytherapy Sources in an ASC.

The Medicare Improvement for Patients and Providers Act of 2008 requires CMS to pay
for brachytherapy sources for the period of July 1, 2008 through December 31, 2009, at
hospitals’ charges adjusted to costs. As a result of the legislative amendment, there is no
prospective rate under the OPPS for that period. Therefore, contrary to the payment
policy, payment indicators and payment rates included in previous guidance, including
Addendum BB to the November 27, 2007 OPPS/ASC final rule, for dates of service July
1, 2008 through December 31, 2009, payment for brachytherapy sources will be made at
contractor-priced amounts, consistent with payment policy for the revised ASC payment
system when no OPPS prospective rate is available. CR-6205

Note that when billing for stranded sources, providers should bill the number of units
of the appropriate source HCPCS C-code according to the number of brachytherapy
sources in the strand, and should not bill as one unit per strand.

For electronic billing in item 19 narrative, list iodine (I-125); palladium (Pd-103); and
cesium (Cs-131), the number of seeds ordered, invoice price and the number of seeds used
in the procedure. It is recognized that a small number of additional seeds is ordered and
billed to cover plan changes or intra-operative loss.

Until standard pricing can be established, the contractor will request by mail additional documentation (operative note and seed invoice) to confirm billed amount and number of seeds used.

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