Jul 6, 2016
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,...
May 25, 2016
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...
May 20, 2016
Magnetic Resonance Angiography (MRA) Magnetic Resonance Angiography (MRA) Coverage Summary Section 1861(s)(2)(C) of the Social Security Act provides for coverage of diagnostic testing. Coverage of magnetic resonance angiography (MRA) of the head and neck,...
May 18, 2016
Effective September 28, 2009 The Centers for Medicare & Medicaid Services (CMS) finds that the non-coverage of magnetic resonance imaging (MRI) for blood flow determination is no longer supported by the available evidence. CMS is removing the phrase “blood flow...
May 15, 2016
Payment for Low Osmolar Contrast Material (LOCM) (Radiology) Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors: June 11, 2013, ICD-10: Upon Implementation of ICD-10 Implementation: ASC X12: November 10, 2014 Fluorodeoxyglucose (FDG) Positron...
May 12, 2016
Computerized Axial Tomography (CT) Procedures A/B MACs (B) 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...
May 10, 2016
Questionable Business Arrangements No special charge or payment constraints are imposed on tests performed by a physician or a technician under the physician’s supervision. There are two requirements for all diagnostic tests under §1861(s)(3) of the Act, as...
