Payment for Radiopharmaceuticals

Radiopharmaceuticals are not subject to the fee schedule, but are paid based on reasonable cost when given in a SNF. SNFs report HCPCS codes 79900, A4641, A4642, A9500, A9503, and A9505, as appropriate, with revenue codes 0333, 034X, or 0636.

NOTE: The correct code to report is A4641. It replaced HCPCS code 78990. HCPCS code 78990 should not be reported because this code is not valid for Medicare purposes.

EXCEPTION: HCPCS codes 77781, 77782, 77783, and 77784 include payment for the radiopharmaceutical in the technical component. When these procedures are performed, SNFs do not report radiopharmaceutical codes 79900, A4641, A4642, A9500, A9503, and A9505. The A/B MAC (A) will reject codes 79900, A4641, A4642, A9500, A9503, and A9505 when they are billed for supplies used in conjunction with procedure codes 77781, 77782, 77783, and 77784.

 Aborted Procedure

vWhen a procedure is not completed, the SNF should bill an unlisted code (e.g., Procedure  code ending in 99) and show the actual charges for the procedure. The A/B MAC (A) will request additional data from the SNF to determine applicable payment. Deductible and coinsurance apply based on fee schedule rules.

Combined Procedures (Radiology)

There are no separate codes covering certain combined procedures, e.g., a hand and forearm included in a single x-ray. The code with the higher fee schedule amount should be used.