NUCLEAR MEDICINE APC TASK FORCE

Transcription

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 FOR RADIOPHARMACEUTICALS AND DRUGS UNDER APC s 1850 Samuel Morse Drive Reston, VA (703) Fax: (703) Addendum B Calendar year 2003 Hospital Outpatient Payment Rates, effective January 1, 2003: January 2003 Update of the Hospital Outpatient Prospective Payment System (OPPS), CMS Memorandum A , dated January 3, 2003, effective for services on or after January 1, 2003: April 2003 Update of the Hospital Outpatient Prospective Payment System (OPPS), CMS Memorandum A , dated April 2, 2003, effective for services on or after April 1, 2003: 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 Packaged S Significant Procedure, Not Discounted When Multiple Paid Under Outpatient PPS T Significant Procedure, Multiple Procedure Reduction Applies Paid Under Outpatient PPS X Ancillary Service Paid Under Outpatient PPS 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 CMS web site. 1

2 Revenue Codes: CMS has stated that hospitals should continue to use revenue code 0636 when reporting radiopharmaceuticals or drugs eligible for separate continued payment, status indicator K or G listed in this table. For those drugs and radiopharmaceuticals packaged status indicator N, CMS in the April 2, 2003 PM, gave direction to hospitals to use revenue code 025X or 062X. For your information, revenue code 0621 has a description of Supplies Incident to Radiology, 0622 Supplies Incident to Other Diagnostic Services, 025X is Pharmacy and 0255 Drugs Incident to Radiology. Given the codes and descriptions available the NM APC TF suggests hospitals choose revenue code 0622 for Nuclear Medicine Drugs and Radiopharmaceuticals that are packaged and designated as status indicator N. A4641 N Packaged into A4642 N Packaged into A9500 N Packaged into A9502 N Packaged into A9503 N Packaged into A9504 N Packaged into Diagnostic Imaging Agent Supply of Radiopharmaceutical Diagnostic Imaging Agent, not otherwise classified Satumomab Pendetide, per dose Supply of Satumomab Pendetide, Radiopharmaceutical Diagnostic Imaging Agent, per dose Technetium Tc99m Sestimibi Tc99m Sestimibi, per dose Technetium Tc99m tetrofosmin, per dose Tc99m Tetrofosmin, per unit dose Technetium Tc99m medronate, [per dose - up to 30 mci] Tc99m Medronate, per dose (up to 30 mci) Technetium Tc99m apcitide, per vial Tc99m Apcitide, per vial A9505 N Packaged into Tl-201, per mci Supply of Radiopharmaceutical Diagnostic Imaging Agent, Thallous Chloride Tl201, per mci A9507 K 1604 $ In-111 capromab pendetide, per dose Supply of Radiopharmaceutical Diagnostic Imaging Agent, Indium 111 Capromab Pendetide, per dose ONCOSCINT CARDIOLITE MYOVIEW MDP ACUTECT THALLIUM 201 PROSTASCINT 2

3 A9508 K 1045 $81.86 or $ Check with your local FI A9510 N Packaged into Iobenguane Sulfate I-131, per 0.5 mci Supply of Radiopharmaceutical Diagnostic Imaging Agent, Iobenguane Sulfate I-131, per 0.5 mci (Modification to APC Group-change from what was published in the November 1, 2002 Final Rule, see CMS Transmittal A , dated April 2, 2003) (C1045 changed to A9508, see CMS Transmittal A , dated January 3, 2003) Technetium Tc-99m Disofenin, per vial Supply of Radiopharmaceutical Diagnostic Imaging Agent, Disofenin, per vial A9511 K 1095 $ Technetium Tc99m Depreotide, per mci Tc99m Depreotide, per mci A9512 N Packaged into Technetium Tc99m Pertechnatate MIBG NEOTEC A9513 N Packaged into A9514 N Packaged into A9515 N Packaged into A9516 N Packaged into A9517 N Packaged into Tc99m Mebrofenin Tc99m Mebrofenin, per vial Tc99m Pyrophosphate Tc99m Pyrophosphate, per vial Tc99m Pentetate Tc99m Pentetate, per vial I-123 Sodium Iodide Capsule I-131 Sodium Iodide Capsule CHOLETEC PYROLITE Tc-99m DTPA 3

4 A9518 K 1348 $0.05 I 131 Solution, per uci A9519 N Packaged into A9520 N Packaged into Tc99m macroag albu Tc99m Albumin Aggregated, per 1.0 mci Tc99m Sulfur Colloid, per dose Tc99m A9521 K 1096 $ Tc99m Exametazime Tc99m Exametazime, per dose A9522 N Packaged into A9523 N Packaged into A9524 N Packaged into Indium 111 Ibritumomabtiuxetan See G0273 Yttrium 90 Ibritumomabtiuxetan See G0274 Iodinated I-131 albumin Supply of Radiopharmaceutical Diagnostic Imaging Agent, Iodinated I- 131 Albumin, per mci A9600 K 0701 $ Strontium-89 chloride, per mci Supply of Radiopharmaceutical Diagnostic Imaging Agent, Strontium- 89 Chloride, per mci A9603 N Packaged into I-131 Sodium Iodide Capsule, per mci A9605 K 0702 $ Samarium Sm153 Lexidronamm, per 50 mci Supply of Radiopharmaceutical Diagnostic Imaging Agent, Samarium Sm153 Lexidronamm, per 50 mci MAA SULFUR COLLOID (SC) CERETEC METASTRON QUADRAMET 4

5 C1045 K 1045 $ Iobenguane sulfate I-131 per 0.5 mci C1079 N Packaged into (Modification to APC Group-change from what was published in the November 1, 2002 Final Rule, see CMS Transmittal A , dated April 2, 2003) (C1045 changed to A9508, see CMS Transmittal A , dated January 3, 2003) Co 57/58, 0.5 uci Supply of Radiopharmaceutical Diagnostic Imaging Agent, Cyanocobalamin Co 57/58, per 0.5 uci C1091 K 1091 $ In-111 Oxyquinoline, per 0.5 mci Supply of Radiopharmaceutical Diagnostic Imaging Agent, Indium 111 Oxyquinoline, per 0.5 mci C1092 K 1092 $ In-111 pentetate per 0.5 mci Supply of Radiopharmaceutical Diagnostic Imaging Agent, Indium 111 Pentetate, per 0.5 mci C1122 K 1122 $ Tc99m Arcitumomab, per vial Tc99m Arcitumomab, per vial C1200 N Packaged into C1201 N Packaged into C1775 K 1775 $ FDG, per dose (4-40 mci) Tc99m Sodium Glucoheptonate Tc99m Sodium Glucoheptonate, per vial Tc99m Succimer, per vial Tc99m Succimer, per vial Supply of radiopharmaceutical diagnostic imaging agent, fluorodeoxyglucose F18 (2-deoxy-2-[18F]fluoro-D-glucose), per dose (4-40 mci/ml) MIBG Nycomed Used with WBC labeling Indium DTPA CEA-SCAN GLUCOSCAN DMSA 5

6 C9000 K 9000 $98.03 Na Chromate Cr51, per 0.25 mci Injection, Sodium Chromate Cr51, per 0.25 mci C9102 N Packaged into C9103 N Packaged into J0150 N Packaged into 51Na Chromate, per 50 mci Supply of Radiopharmaceutical Diagnostic Imaging Agent, 51 Sodium Chromate, per 50 mci Na Iothalamate I-125, 10 µci Supply of Radiopharmaceutical Diagnostic Imaging Agent, Sodium Iothalmate I-125 Injection, per 10 uci Injection adenosine 6 mg Injection Adenosine, 6 mg (not to be used to report any adenosine phosphate compounds, instead use A9270) ADENOCARD J0151 K 917 $ Adenosine Injection, per 90 mg. ADENOSCAN J1245 N Packaged into Dipyridamole injection Injection, Dipyridamole, per 10 mg Q3000 K 9025 $ Rubidium RB-82 Supply of radiopharmaceutical diagnostic imaging agent, rubidium RB- 82, per dose Q3002 N Packaged into Gallium Ga-67, per mci Supply of Radiopharmaceutical Diagnostic Imaging Agent, Gallium Ga 67, per mci Q3003 K 1620 $ Technetium Tc99m Bicisate, per dose Tc99m Bicisate, per unit dose Q3004 N Packaged into Xenon Xe 133, per 10 mci Supply of Radiopharmaceutical Diagnostic Imaging Agent, Xenon Xe 133, per 10 mci Gallium NEUROLITE Xenon 6

7 Q3005 N Packaged into Q3006 N Packaged into Q3007 N Packaged into Technetium Tc99 mertiatide, per mci Tc99m Mertiatide, per mci Technetium Tc99m Glucepatate Tc99m Glucepatate, per 5 mci Sodium phosphate P-32 Supply of Radiopharmaceutical Diagnostic Imaging Agent, Sodium Phosphate P32, per mci Q3008 K 1625 $ Indium 111 Pentetreotide Supply of Radiopharmaceutical Diagnostic Imaging Agent, Indium 111-In Pentetreotide, per 3 mci Q3009 N Packaged into Q3010 N Packaged into Technetium Tc99m Oxidronate Tc99m Oxidronate, per mci Tc-99m Labeled Red Blood Cells Tc99m Labeled Red Blood Cells, per mci Q3011 K 1628 $82.87 Chromic Phosphate P32 Supply of Radiopharmaceutical Diagnostic Imaging Agent, Chromic Phosphate P32 Suspension, per mci Q3012 N Packaged into Co57, 0.5 mci Supply of Radiopharmaceutical Diagnostic Imaging Agent, Cyanocobalamin Cobalt Co57, per 0.5 mci TECHNESON MAG-3 GLUCOSCAN OCTREOSCAN HDP ULTRATAG or Cold PYP Code to be used for the invivo/invitro methods of tagging Red Blood Cells 7

8 Additional Changes per CMS Program Memorandum A COMMENTS S 0285 $ Heart muscle imaging (PET) E Provision of Diagnostic Radionuclide G0252 E PET imaging initial dx Radiopharmaceutical Biodistribution and Radiopharmaceutical Therapy Procedure Codes COMMENTS G0273 S 0718 Pretx planning, non-hodgkin s $2, G0274 S 0725 Radiopharm tx, non-hodgkin s $20, Radiopharmaceutical biodistribution, single or multiple scans on one or more days, pre-treatment planning for radiopharmaceutical therapy of non-hodgkin s lymphoma, includes administration of radiopharmaceutical (e.g., radiolabeled antibodies) Radiopharmaceutical Therapy, non-hodgkin s lymphoma, includes administration of radiopharmaceutical (e.g., radiolabeled antibodies) See section XVII of CMS Program Memorandum A , dated January 3, Code created because there is no existing code for this service. 8