RADIOPHARMACEUTICALS AND DRUGS ELIGIBLE FOR CONTINUED SEPARATE MEDICARE PAYMENT ( 2 TO 3 Year Transitional Period )

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1 NUCLEAR MEDICINE APC TASK FORCE American College of Nuclear Physicians American Society of Nuclear Cardiology Council on Radionuclides and Radiopharmaceuticals, Inc. Academy of Molecular Imaging Society of Nuclear Medicine Society of Nuclear Medicine - Technologist Section Q3007 Payment Correction (SNM Chart) June 24, Samuel Morse Drive Reston, VA (703) Fax: (703) April 1, 2002 RADIOPHARMACEUTICALS AND DRUGS ELIGIBLE FOR CONTINUED SEPARATE MEDICARE ( 2 TO 3 Year Transitional Period ) We suggest that you monitor the SNM web page for updated information at Average Wholesale Price (AWP) updates may be made to the REDBOOK at any time. Medicare payment is currently based on 95% of AWP. Addendum B Calendar Year 2002 Hospital Outpatient Payment Rates, effective April 1, 2002: Technical Corrections to Calendar Year 2002 Hospital Outpatient Payment Rates: 2002 Update of the Hospital Outpatient Prospective Payment System (OPPS), CMS Memorandum A , March 28, 2002, effective April 1, Pro-rata in Drug and Device Pass-Through Payments: The final rule published in the Federal Register on March 1, 2002, announced a uniform reduction of 63.6% to be applied to each of the transitional pass-through payments for drugs and devices provided on or after April 1, The Federal Registers published on November 1, 2001, November 30, 2001 and March 1, 2002 provide a full discussion of these reductions. There are several different pro-rata reduction-based formulas dependent on the sole source, generic or multi-source, and/or other classification of the drug/device category. Example of a sole-source drug pass-through pro-rata reduction can be found at the end of the radiopharmaceutical chart. Note: CMS short description limited by field size, details of long description for each radiopharmaceutical:

2 A4641 N Diagnostic Imaging Agent A4642 Deleted Replaced by C $1, $1, Satumomab Pendetide not otherwise classified Supply of Satumomab Pendetide, Radiopharmaceutical Diagnostic Imaging Agent, per dose A9500 G 1600 $ $ Technetium Tc99m Sestimibi Technetium Tc99m Sestimibi, per dose ONCOSCINT CARDIOLITE A9502 G 0705 $ $93.00 Technetium Tc99m tetrofosmin, per dose Technetium Tc99m Tetrofosmin, per unit dose A9503 G 1601 $42.18 $32.00 Technetium Tc99m medronate, [per dose - up to 30 mci] Technetium Tc99m Medronate, per dose (up to 30 mci) A9504 G 1602 $ $ Technetium Tc99m apcitide, per vial A9505 G 1603 $78.16 $51.00 Multi-source drug Technetium Tc99m Apcitide, per vial Tl-201, per mci Thallous Chloride Tl201, per mci MYOVIEW MDP ACUTECT THALLIUM 201

3 A9507 G 1604 $2, $1, In-111 capromab pendetide, per dose Indium 111 Capromab Pendetide, per dose A9508 G 1045 $ $ Iobenguane Sulfate I-131, per 0.5 mci Iobenguane Sulfate I-131, per 0.5 mci A9510 G 1205 $79.17 $65.00 Technetium Tc-99m Disofenin, per vial Disofenin, per vial A9511 G 1095 $38.00 $31.00 Technetium Tc99m Depreotide, per mci Technetium Tc99m Depreotide, per mci A9600 G 0701 $ $ Strontium-89 chloride, per mci Strontium-89 Chloride, per mci A9605 G 0702 $1, $ Samarium Sm153 Lexidronamm, per 50 mci C1058 G 1058 $36.74 $30.00 Tc99m oxidronate, per vial Samarium Sm153 Lexidronamm, per 50 mci PROSTASCINT Replaces C1045 Replace C1205 NEOTEC NEW code April 1, 2002 METASTRON QUADRAMET C1064 G 1064 $5.86 $4.00 I-131 Cap, each add l. mci New Descriptor C1065 G 1065 $15.81 $12.00 I-131 Sol, each add mci New Descriptor

4 C1066 G 1066 $1, $1, IN-111 Sataumomab Pendetide NEW C1079 G 1079 $ $ Co 57/58, 0.5 uci Indium 111 satumomab pendetide, per vial Cyanocobalamin Co 57/58, per 0.5 uci ONCOSCINT Nycomed C1087 G 1087 $0.65 $0.42 I-123 (capsule), per 100 mci, dx use I-123 Diagnostic C1090 Deleted D In-111 chloride, per mci Indium 111 Chloride, per mci C1091 G 1091 $ $ In-111 Oxyquinoline, per 0.5 mci C1092 G 1092 $ $ In-111 pentetate per 0.5 mci Indium 111 Oxyquinoline, per 0.5 mci Indium 111 Pentetate, per 0.5 mci C1094 G 1094 $33.09 $25.00 Tc99m Albumin Aggregate, 1.0 mci C1095 Use A9511 D 1095 $38.00 $31.00 Tc99m Depreotide, per vial Technetium Tc99m Albumin Aggregated, per 1.0 mci Technetium Tc99m Depreotide, per vial INDICLOR Used with WBC labeling Note Change in Description Indium DTPA MAA Note Change in Description Use A9511

5 C1096 G 1096 $ $ Tc99m Exametazime, per dose C1097 G 1097 $51.44 $42.00 Tc99m Mebrofenin, per vial C1098 G 1098 $22.43 $17.00 Tc99m Pentetate, per vial Technetium Tc99m Exametazime, per dose Technetium Tc99m Mebrofenin, per vial Technetium Tc99m Pentetate, per vial C1099 G 1099 $39.11 $32.00 Tc99m Pyrophosphate, per vial Technetium Tc99m Pyrophosphate, per vial C1122 G 1122 $1, $1,012 Tc99m Arcitumomab, per vial C1188 G 1188 $ $90.00 I-131 Cap, per 1-5 mci Technetium Tc99m Arcitumomab, per vial Sodium Iodide I-131, Capsule, per initial 1-5 mci C1200 G 1200 $22.61 $19.00 Tc99m Sodium Glucoheptonate C1201 G 1201 $ $ Tc99m Succimer, per vial Technetium Tc99m Sodium Glucoheptonate, per vial Technetium Tc99m Succimer, per vial CERETEC CHOLETEC Tc-99m DTPA PYROLITE CEA-SCAN Note Change in Description GLUCOSCAN DMSA

6 C1202 G 1202 $76.00 $59.00 Tc99m Sulfur Colloid, per dose Technetium Tc99m C1207 G 1207 $ $ Octreotide Acetate Depot 1 mg C1348 G 1348 $ C1775 NEW Multi-source drug Octreotide Acetate 1 mg I 131 Sol, per 1-6 mci G 1775 $ $ FDG, per dose (4-40 mci) Sodium Iodide I-131, Solution, per initial 1-6 mci Supply of radiopharmaceutical diagnostic imaging agent, fluorodeoxyglucose F18 (2-deoxy-2-[18F]fluoro-D-glucose), per dose (4-40 mci/ml) C9000 G 9000 $0.52 $0.42 Na Chromate Cr51, per 0.25 mci Injection, Sodium Chromate Cr51, per 0.25 mci C9013 G 9013 $81.10 $63.00 Co57 Cobaltous Chloride, per 10 uci Supply of Co57 Cobaltous Chloride, Radiopharmaceutical Diagnostic Imaging Agent, per uci C9100 G 9100 $10.34 $8.00 Iodinated I-131 albumin, per mci C9102 G 9102 $64.84 $ Na Chromate, per 50 mci Iodinated I-131 Albumin, per mci 51 Sodium Chromate, per 50 mci SULFUR COLLOID (SC) Somastatin Note Change in Description

7 C9103 G 9103 $17.18 $14.00 Na Iothalamate I-125, 10 µci J0150 K 0917 $17.82 Injection adenosine 6 mg J1245 K 0917 $17.82 Dipyridamole injection Q3002 G 1619 $25.62 $17.00 Multi-source drug Sodium Iothalmate I-125 Injection, per 10 uci Injection Adenosine, 6 mg (not to be used to report any adenosine phosphate compounds, instead use A9270) Injection, Dipyridamole, per 10 mg Gallium Ga-67, per mci Gallium Ga 67, per mci Q3003 G 1620 $ $ Technetium Tc99m Bicisate, per dose Q3004 G 1621 $29.93 $19.00 Multi-source drug Technetium Tc99m Bicisate, per unit dose Xenon Xe 133, per 10 mci Xenon Xe 133, per 10 mci Q3005 G 1622 $ $ Technetium Tc99 mertiatide, per mci Technetium Tc99m Mertiatide, per mci Q3006 G 1623 $22.61 $18.00 Technetium Tc99m Glucepatate Technetium Tc99m Glucepatate, per 5 mci Gallium NEUROLITE Xenon TECHNESON MAG-3 GLUCOSCAN

8 Q3007 G 1624 $81.10 $66.00 Sodium phosphate P-32 Q3008 G 1625 $ $ Indium 111-in Pentetreotide Sodium Phosphate P32, per mci Indium 111-In Pentetreotide, per 3 mci Q3009 G 1626 $1.47 $1.20 Technetium Tc99m Oxidronate Technetium Tc99m Oxidronate, per mci Q3010 G 1627 $40.90 $33.00 Tc-99m Labeled Red Blood Cells Q3011 G 1628 $ $ Chromic Phosphate P32 Q3012 G 3012 $81.10 $66.00 Co57, 0.5 mci Technetium Tc99m Labeled Red Blood Cells, per mci Chromic Phosphate P32 Suspension, per mci Cyanocobalamin Cobalt Co57, per 0.5 mci OCTREOSCAN HDP ULTRATAG Replaces C1089 April 1, 2002 The common and brand names for the chemicals and compounds listed were researched and added for your convenience. If there is a radiopharmaceutical missing from the list please, check the web site. Additional Notes: CMS has stated that hospitals should use revenue code 636 when reporting radiopharmaceuticals or drugs eligible on the pass-through list. Other Revenue Codes: Diagnostic nuclear medicine imaging procedure revenue code 340 and PET imaging procedure revenue code 404.

9 Status Indicators Indicator Service Status D Deleted Codes Are Deleted Effective with the Beginning of the Calendar Year E Non-Covered Items and Services Not Paid Under Outpatient PPS. G Drug/Biological Pass-Through Additional Payment K Non Pass-Through Drug/Biological Paid Under Outpatient PPS N Incidental services, packaged into APC rate Packaged S Significant Procedure, Not Discounted When Multiple Paid Under Outpatient PPS T Significant Procedure, Multiple Procedure Applies Paid Under Outpatient PPS X Ancillary Service Paid Under Outpatient PPS

10 Pro Rata Estimation Sole Source Radiopharmaceutical with AWP of $100 (example) By statute, the total Medicare payment is 95% of AWP (95% of AWP = total Medicare Payment) = $95.00 a. Calculate Acquisition costs (base APC payment using the AWP) ($100 x 0.68) = $68.00 b. Determine Pass-through portion (Total Medicare payment [95% of AWP] minus acquisition cost ($ $68.00) = $27.00 c. Calculate the pro rata reduction by multiplying the pass-through portion by (0.636 x $27.00) = $17.17 d. Calculate the new 2002 pass-through payment by subtracting the calculated pro rata reduction amount from the pass-through ($ $17.17) = $ 9.83 e. Calculated Acquisition costs + calculated new 2002 pass-through payment ($ $9.83) = Total Medicare Payment = $77.83 In this example, the hospital payment is reduced $17.17, representing an 18% reduction. You may also use the following formula to estimate payment for sole - source radiopharmaceuticals: Medicare Payment Rate x = New 2002 Payment with reduction ($77.83) Or 82% of the Medicare Payment Rate = New 2002 Payment with reduction ($77.90) Multi-Source Products: Multi-source products and products with generic competitors, the pro rata reduction is calculated differently, e.g. determine the passthrough portion of the Medicare payment which is the difference between the acquisition costs (5 times co-pay) and 95% of AWP, and calculate reduction.