HOPPS 2012F vs 2013P

Document Sample
HOPPS 2012F vs 2013P Powered By Docstoc
					                                                                                                                                                                                                                                                                       WWW.SNM.ORG




                                        FINAL 2012 Compared to Proposed 2013 Rates
                            Medicare Hospital Outpatient Prospective Payment System HOPPS (APC)
                               Nuclear Medicine Procedures, Radiopharmaceuticals, and Drugs
                                                              CMS Website HOPPS CY 2013 PROPOSED Rule
                                                                        Updated July 6, 2012
                                               CMS ADDENDUM D1. Final OPPS Payment Status Indicators for CY 2013
Indicator                                                     Service                                                                     Status
    A       Services furnished to a hospital outpatient that are paid under a fee schedule or payment Not paid under OPPS. Paid by fiscal intermediaries/MACs under a fee
            system other than OPPS                                                                    schedule or payment system other than OPPS. Services are subject to
    B       Codes that are not recognized by OPPS when submitted on an outpatient hospital Part B
                                                                                                            Not paid under OPPS.
            bill type (12x and 13x).
    D       Discontinued Codes                                                                              Not paid under OPPS or any other Medicare Payment System.
    E       Items, Codes, and Services: That are not covered by any Medicare outpatient benefit
            based on statutory exclusion; That are not covered by any Medicare outpatient benefit
                                                                                                            Not paid by Medicare when submitted on outpatient claims (any
            for reasons other than statutory exclusion; That are not recognized by Medicare for
                                                                                                            outpatient bill type).
            outpatient claims but for which an alternate code for the same item or service may be
            available; For which separate payment is not provided on outpatient claims.

    G       Pass-Through Drug/ Biologicals                                                                  Paid under OPPS; separate APC payment.
    H
            Pass-through Device Categories                                                                  Separate cost-based pass-through payment; not subject to copayment.

    K       NonPass-Through Drugs and nonimplantable Biologicals, including Therapeutic
                                                                                                            Paid under OPPS; separate APC payment.
            Radiopharmaceuticals
    N                                                                                                       Paid under OPPS; payment is packaged into payment for other
            Items and Services packaged into APC rate
                                                                                                            services. Therefore, there is no separate APC payment.
   Q1                                                                                                       Paid under OPPS; Addendum B displays APC assignments when services are
            STVX-Packaged Codes (e.g 38792 separately payable is only item on claim for SDOS)               separately payable. (1) Packaged APC payment if billed on the same date of
                                                                                                            services as a HPCS code assigned status indicator "s, " "T," "V," or "X."

    S       Significant Procedure, Not Discounted When Multiple
    T       Significant Procedure, Multiple Procedure Reduction Applies                                     Paid under OPPS; separate APC payment.
    U       Brachytherapy Sources
    X       Ancillary Service

                                                                                                                                      2013-        FINAL RULE    PROPOSED
  CPT/                                                                               Trade         2012-F    2013-P       2012-F
                                                                                                                                        P            CY 2012    RULE CY 2013
                                                                                                                                                                                    %

                                                                                                                                                    Payment
HCPCS                               Description                                      Name           APC        APC            SI         SI
                                                                                                                                                      Rate
                                                                                                                                                                Payment Rate Change
▲◘ 38792
 Revised Injection procedure; radioactive tracer for identification of sentinel node                0392      0392           Q1         Q1         $160.28        $197.86       23.45%
  2012
         Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes
         injection of non-radioactive dye, when performed
 l38900 (List separately in addition to code for primary procedure)
  New    (For injection of radioactive tracer for identification of sentinel node, use 38792)       N/A        N/A          N/A        N/A            N/A            N/A
  2011   (Use in conjunction with 19302,19307,38500,38510,
         38520,38525,38530,38542,38740,38745)

            Injection procedure (eg, contrast media) for evaluation of previously placed                                                        Packaged        Packaged
  49427     peritoneal-venous shunt (For radiological supervision and interpretation, see                                     N          N      into APC        into APC          N/A
            75809, 78291)
                                                                                                                                                   rate            rate
            Insertion of non-indwelling bladder catheter (eg, straight catheterization for
  51701     residual urine)                                                                        0340       0340            X          X          $45.50        $48.95         7.58%

  51702     Insertion of temporary indwelling bladder catheter; simple (eg, Foley)                 0340       0340            X          X          $45.50        $48.95         7.58%
            Insertion of temporary indwelling bladder catheter; complicated (eg, altered
  51703     anatomy, fractured catheter/balloon)                                                   0126       0126            T          T          $77.68        $78.91         1.58%
            3D rendering with interpretation and reporting of computed of computed
            tomography, magnetic resonance imaging, ultrasound, or other tomographic
            modality; not requiring image postprocessing on an independent workstation (Use
            76376 in conjunction with codes(s) for base imaging procedure(s))                                                                      Packaged
                                                                                                                                                                  Packaged
  76376
            (Do not report 76376 in conjunction with 70496, 70498, 70544-70549, 71275,              N/A         N/A          N/A        N/A        into APC                       N/A
                                                                                                                                                                into APC rate
            71555, 72159, 72191, 72198, 73206, 73225, 73706, 73725, 74175, 74185,                                                                     rate
            75557-75564, 75635, 76377, 78000-78999, 0066T, 0067T, 0144T-0151T,
            0159T)
            3D rendering with interpretation and reporting of computed of computed
            tomography, magnetic resonance imaging, ultrasound, or other tomographic
            modality; requiring image postprocessing on an independent workstation (Use
            76377 in conjunction with codes(s) for base imaging procedure(s))
                                                                                                                                                   Packaged
                                                                                                                                                                  Packaged
  76377
            (Do not report 76377 in conjunction with 70496, 70498, 70544-70549, 71275,              N/A         N/A          N/A        N/A        into APC                       N/A
                                                                                                                                                                into APC rate
            71555, 72159, 72191, 72198, 73206, 73225, 73706, 73725, 74175, 74185,                                                                     rate
            75557-75564, 75635, 76376, 78000-78999, 0066T, 0067T, 0144T-0151T,
            0159T)
  77370     Special medical radiation physics consultation                                          0304       0304           X          X          $107.33       $109.68        2.19%
NUCLEAR MEDICINE Modified in 2006 INTRODUCTORY SECTION - The services listed do not include the radiopharmaceutical or drug. Diagnostic and therapeutic
radiopharmaceuticals and drugs supplied by the physician should be reported separately using the appropriate supply code(s), in addition to the procedure code.

 78000      Thyroid uptake; single determination                                                    0389       0389           S          S          $109.01       $115.47        5.93%
 78001      Thyroid uptake; multiple determinations                                                 0389       0389           S          S          $109.01       $115.47        5.93%
            Thyroid uptake; stimulation, suppression or discharge (not including initial                                                                          $115.47
 78003                                                                                              0389       0389           S          S          $109.01                      5.93%
            uptake studies)
 78006      Thyroid imaging with uptake; single determination                                       0391       0391           S          S          $221.32       $234.17        5.81%
 78007      Thyroid imaging with uptake; multiple determinations                                    0391       0391           S          S          $221.32       $234.17        5.81%
 78010      Thyroid imaging: only                                                                   0390       0390           S          S          $132.64       $150.44        13.42%
 78011      Thyroid imaging: with vascular flow                                                     0390       0390           S          S          $132.64       $150.44        13.42%

 78015      Thyroid carcinoma metastases imaging; limited are (eg, neck and chest only)             0406       0406           S          S          $280.44       $300.86        7.28%

            Thyroid carcinoma metastases imaging; with additional studies (eg, urinary
 78016                                                                                              0406       0406           S          S          $280.44       $300.86        7.28%
            recovery)
 78018      Thyroid carcinoma metastases imaging; whole body                                        0406       0406           S          S          $280.44       $300.86        7.28%
        Thyroid carcinoma metastases uptake (Use in conjunction with code 78018                                                                    Packaged      Packaged
78020 + only)                                                                                       N/A         N/A           N          N
                                                                                                                                                   into APC                        N/A
                                                                                                                                                                 into APC
 78070      Parathyroid imaging                                                                     0391       0391           S          S            rate
                                                                                                                                                    $221.32       $234.17        5.81%
 78075      Adrenal imaging, cortex and/or medulla                                                  0408       0408           S          S          $957.47       $975.89        1.92%
 78099      Unlisted endocrine procedure, diagnostic nuclear medicine                               0390       0390           S          S          $132.64       $150.44        13.42%
 78102      Bone marrow imaging; limited area                                                       0400       0400           S          S          $256.12       $279.77        9.23%
 78103      Bone marrow imaging; multiple areas                                                     0400       0400           S          S          $256.12       $279.77        9.23%
 78104      Bone marrow imaging; whole body                                                         0400       0400           S          S          $256.12       $279.77        9.23%
            Plasma volume, radiopharmaceutical volume-dilution technique (separate
 78110                                                                                              0393       0393           S          S          $484.48       $423.30       -12.63%
            procedure); single sampling
            Plasma volume, radiopharmaceutical volume-dilution technique (separate
 78111                                                                                              0393       0393           S          S          $484.48       $423.30       -12.63%
            procedure); multiple sampling

 78120      Red cell volume determination (separate procedure); single sampling                     0393       0393           S          S          $484.48       $423.30       -12.63%

 78121      Red cell volume determination (separate procedure); multiple sampling                   0393       0393           S          S          $484.48       $423.30       -12.63%
            Whole blood volume determination, including separate measurement of
 78122      plasma volume and red cell volume (radiopharmaceutical volume-dilution                  0393       0393           S          S          $484.48       $423.30       -12.63%
            technique)
 78130      Red cell survival study;                                                                0393       0393           S          S          $484.48       $423.30       -12.63%
            Red cell survival study; differential organ/tissue kinetics (eg, splenic and/or
 78135                                                                                              0393       0393           S          S          $484.48       $423.30       -12.63%
            hepatic sequestration)
            Labeled red cell sequestration, differential organ/tissue, (eg, splenic and/or
 78140                                                                                              0393       0393           S          S          $484.48       $423.30       -12.63%
            hepatic)
            Spleen imaging only, with or without vascular flow (If combined with liver study,
 78185                                                                                              0400       0400           S          S          $256.12       $279.77        9.23%
            use procedures 78215 and 78216)
            Kinetics, study of platelet survival, with or without differential organ/tissue
 78190                                                                                              0392       0392           S          S          $160.28       $197.86        23.45%
            localization
 78191      Platelet survival study                                                                 0392       0392           S          S          $160.28       $197.86        23.45%
            Lymphatics and lymph nodes imaging (For sentinel node identification without
 78195                                                                                              0400       0400           S          S          $256.12       $279.77        9.23%
            scintigraphy imaging, use 38792)
            Unlisted hematopoietic, Reticuloendothelial and lymphatic procedure,
 78199                                                                                              0400       0400           S          S          $256.12       $279.77        9.23%
            diagnostic nuclear medicine
 78201      Liver imaging; static only                                                              0394       0394           S          S          $293.43       $314.78        7.28%
 78202      Liver imaging; with vascular flow                                                       0394       0394           S          S          $293.43       $314.78        7.28%
 78205      Liver imaging (SPECT);                                                                  0394       0394           S          S          $293.43       $314.78        7.28%
 78206      Liver image (SPECT); with vascular flow                                                 0394       0394           S          S          $293.43       $314.78        7.28%
 78215      Liver and spleen imaging; static only                                                   0394       0394           S          S          $293.43       $314.78        7.28%
 78216      Liver and spleen imaging; with vascular flow                                            0394       0394           S          S          $293.43       $314.78        7.28%
 l78226     Hepatobiliary system imaging, including gallbladder when present                        0394       0394           S          S          $293.43       $314.78        7.28%
            Hepatobiliary system imaging, including gallbladder when present; with
 l78227     pharmacologic intervention, including quantitative measurement(s) when                  0394       0394           S          S          $293.43       $314.78        7.28%
            performed
 78230      Salivary gland imaging;                                                                 0395       0395           S          S          $243.94       $257.35        5.50%
 78231      Salivary gland imaging; with serial images                                              0395       0395           S          S          $243.94       $257.35        5.50%
 78232      Salivary gland function study                                                           0395       0395           S          S          $243.94       $257.35        5.50%
 78258      Esophageal motility                                                                     0395       0395           S          S          $243.94       $257.35        5.50%
 78261      Gastric mucosa imaging                                                                  0395       0395           S          S          $243.94       $257.35        5.50%
 78262      Gastroesophageal reflux study                                                           0395       0395           S          S          $243.94       $257.35        5.50%
 78264      Gastric emptying study                                                                  0395       0395           S          S          $243.94       $257.35        5.50%
 78267      Urea breath test, C-14 (isotopic); acquisition for analysis
 78268      Urea breath test, C-14 (isotopic); analysis
 78270      Vit B-12 absorption study (eg, Schilling test); without intrinsic factor                0392       0392           S          S          $160.28       $197.86        23.45%

 78271      Vit B-12 absorption study (eg, Schilling test); with intrinsic factor                   0392       0392           S          S          $160.28       $197.86        23.45%

 78272      Vit B-12 absorption study combined, with and without intrinsic factor                   0392       0392           S          S          $160.28       $197.86        23.45%
 78278      Acute gastrointestinal blood loss imaging                                               0395       0395           S          S          $243.94       $257.35        5.50%
 78282      Gastrointestinal protein loss                                                           0395       0395           S          S          $243.94       $257.35        5.50%

 78290      Intestine imaging (eg, ectopic gastric mucosa, Meckel’s localization, volvulus)         0395       0395           S          S          $243.94       $257.35        5.50%

 78291      Peritoneal-venous shunt patency test (eg, for LeVeen, Denver shunt)                     0395       0395           S          S          $243.94       $257.35        5.50%

 78299      Unlisted gastrointestinal procedure, diagnostic nuclear medicine                        0395       0395           S          S          $243.94       $257.35        5.50%

 78300      Bone and/or joint imaging; limited area                                                 0396       0396           S          S          $247.18       $262.49        6.19%
 78305      Bone and/or joint imaging; multiple areas                                               0396       0396           S          S          $247.18       $262.49        6.19%
 78306      Bone and/or joint imaging; whole body                                                   0396       0396           S          S          $247.18       $262.49        6.19%
 78315      Bone and/or joint imaging; 3 three phase study                                          0396       0396           S          S          $247.18       $262.49        6.19%
 78320      Bone and/or joint imaging; tomographic (SPECT)                                          0396       0396           S          S          $247.18       $262.49        6.19%
            Bone density (bone mineral content) study , 1 or more sites; single photon
 78350                                                                                              N/A         N/A           E          E            N/A            N/A
            absorptiometry
            Bone density (bone mineral content) study , 1 or more sites; dual photon
 78351                                                                                              N/A         N/A           E          E            N/A            N/A
            absorptiometry one or more sites
 78399      Unlisted musculoskeletal procedure, diagnostic nuclear medicine                         0396       0396           S          S          $247.18       $262.49        6.19%
            Determination of central c-v hemodynamics (non-imagine) (eg, ejection
 78414      fraction with probe technique) with or without pharmacologic intervention or            0398       0398           S          S          $297.90       $309.30        3.83%
            exercise, single or multiple determinations
 78428      Cardiac shunt detection                                                                 0398       0398           S          S          $297.90       $309.30        3.83%
 78445      Non-cardiac vascular flow imaging (ie, angiography, venography)                         0397       0397           S          S          $146.89       $192.21        30.85%
            Myocardial perfusion imaging, tomographic (SPECT) (including attenuation
            correction, qualitative or quantitative wall motion, ejection fraction by first pass
 78451                                                                                              0377       0377           S          S          $672.28       $682.43        1.51%
            or gated technique, additional quantification, when performed); single study, at
            rest or stress (exercise or pharmacologic)
            Myocardial perfusion imaging, tomographic (SPECT) (including attenuation
            correction, qualitative or quantitative wall motion, ejection fraction by first pass
 78452      or gated technique, additional quantification, when performed); multiple                0377       0377           S          S          $672.28       $682.43        1.51%
            studies, at rest and/or stress (exercise or pharmacologic) and/or
            redistribution and/or rest reinjection




                             Revision Date: July 6, 2012                                                                                                                                  SNM Reimbursement Hospital Educational Material                                      Page 1 of 4
                             CPT codes copyright by the AMA                                                                                                                                             www.snm.org                         Prepared by Merlino Healthcare Consulting Corp.
                                                                                                                                                                                                                                                        WWW.SNM.ORG




                                                                                                                           2013-   FINAL RULE    PROPOSED
 CPT/                                                                              Trade        2012-F   2013-P   2012-F
                                                                                                                             P       CY 2012    RULE CY 2013
                                                                                                                                                                   %

                                                                                                                                    Payment
HCPCS                             Description                                      Name          APC      APC       SI      SI
                                                                                                                                      Rate
                                                                                                                                                Payment Rate Change

          Myocardial perfusion imaging, planar (including qualitative or quantitative wall
          Injection procedure; radioactive tracer for identification of sentinel node
          motion, ejection fraction by first pass or gated technique, additional                                                                  $682.43
 78453                                                                                           0377     0377      S       S       $672.28                      1.51%
          quantification, when performed); single study, at rest or stress (exercise or
          pharmacologic)
          Myocardial perfusion imaging, planar (including qualitative or quantitative wall
          motion, ejection fraction by first pass or gated technique, additional
 78454                                                                                           0377     0377      S       S       $672.28       $682.43        1.51%
          quantification, when performed); multiple studies, at rest and/or stress
          (exercise or pharmacologic) and/or redistribution and/or rest reinjection
 78456     Acute venous thrombus imaging, peptide                                                0397     0397      S       S       $146.89       $192.21       30.85%
 78457     Venous thrombosis imaging, venogram; unilateral                                       0397     0397      S       S       $146.89       $192.21       30.85%
 78458     Venous thrombosis imaging, venogram; bilateral                                        0397     0397      S       S       $146.89       $192.21       30.85%
           Myocardial imaging, positron emission tomography (PET), metabolic
 78459                                                                                           0308     0308      S       S      $1,038.06     $1,058.20       1.94%
           evaluation
 78466     Myocardial imaging, infarct avid, planar; qualitative or quantitative                 0398     0398      S       S       $297.90       $309.30        3.83%
           Myocardial imaging, infarct avid, planar; with ejection fraction by first pass                                                         $309.30
 78468                                                                                           0398     0398      S       S       $297.90                      3.83%
           technique
           Myocardial imaging, infarct avid, planar; tomographic SPECT with or without
 78469                                                                                           0398     0398      S       S       $297.90       $309.30        3.83%
           quantification
           Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or
           stress (exercise and/or pharmacologic), wall motion study plus ejection
 78472                                                                                           0398     0398      S       S       $297.90       $309.30        3.83%
           fraction, with or without additional quantitative processing (or assessment of
           cardiac function by first pass technique, use 78496)
           Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion
 78473     study plus ejection fraction, at rest and stress (exercise and/or                     0398     0398      S       S       $297.90       $309.30        3.83%
           pharmacologic), with or without additional quantification

           Cardiac blood pool imaging (planar), first pass technique; single study, at rest
 78481     or with stress (exercise and/or pharmacologic), wall motion study plus ejection       0398     0398      S       S       $297.90       $309.30        3.83%
           fraction, with or without quantification

           Cardiac blood pool imaging (planar), first pass technique; multiple studies, at
 78483     rest and with stress (exercise and/or pharmacologic), wall motion study plus          0398     0398      S       S       $297.90       $309.30        3.83%
           ejection fraction, with or without quantification
           Myocardial imaging, positron emission tomography (PET), perfusion; single                                                             $1,058.20
 78491                                                                                           0308     0308      S       S      $1,038.06                     1.94%
           study at rest or stress
           Myocardial imaging, positron emission tomography (PET), perfusion; multiple                                                           $1,058.20
 78492                                                                                           0308     0308      S       S      $1,038.06                     1.94%
           studies at rest and/or stress
           Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion
 78494                                                                                           0398     0398      S       S       $297.90       $309.30        3.83%
           study plus ejection fraction, with or without quantitative processing
        Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right                                           Packaged
78496 + ventricular ejection fraction by first pass technique (Use 78496 in conjunction          N/A      N/A       N       N      into APC
        with 78472)                                                                                                                   rate

 78499     Unlisted cardiovascular procedure, diagnostic nuclear medicine                        0398     0398      S       S       $297.90       $309.30        3.83%

l78579     Pulmonary ventilation imaging (eg, aerosol or gas)                                    0401     0401      S       S       $202.45       $220.11        8.72%
▲78580 Pulmonary perfusion imaging (eg, particulate)                                             0401     0401      S        S      $202.45       $220.11        8.72%

l78582     Pulmonary ventilation imaging (eg, aerosol or gas) and perfusion imaging              0378     0378      S       S       $316.42       $335.67        6.08%

           Quantitative differential pulmonary perfusion, including imaging when
l78597                                                                                           0401     0401      S       S       $202.45       $220.11        8.72%
           performed
           Quantitative differential pulmonary perfusion and ventilation (eg aerosol or
l78598                                                                                           0378     0378      S       S       $316.42       $335.67        6.08%
           gas), including imaging when performed
 78599     Unlisted respiratory procedure, diagnostic nuclear medicine                           0401     0401      S       S       $202.45       $220.11        8.72%
 78600     Brain imaging, less than 4 static views;                                              0403     0403      S       S       $240.91       $263.15        9.23%
 78601     Brain imaging, less than 4 static views; with vascular flow                           0402     0402      S       S       $607.69       $476.99       -21.51%
 78605     Brain imaging, minimum 4 static views;                                                0403     0403      S       S       $240.91       $263.15        9.23%
 78606     Brain imaging, minimum 4 static views; with vascular flow                             0402     0402      S       S       $607.69       $476.99       -21.51%
 78607     Brain imaging, tomographic (SPECT)                                                    0402     0402      S       S       $607.69       $476.99       -21.51%

 78608     Brain imaging, positron emission tomography (PET); metabolic evaluation               0308     0308      S       S      $1,038.06     $1,058.20       1.94%

 78609     Brain imaging, positron emission tomography (PET); perfusion evaluation                                  E       E
 78610     Brain imaging, vascular flow only                                                     0403     0403      S       S       $240.91       $263.15        9.23%
           Cerebrospinal fluid flow, imaging (not including introduction of material);
 78630                                                                                           0402     0402      S       S       $607.69       $476.99       -21.51%
           cisternography (For injection procedure, see 61000-61070, 62270-62319)

           Cerebrospinal fluid flow, imaging (not including introduction of material);
 78635                                                                                           0402     0402      S       S       $607.69       $476.99       -21.51%
           ventriculography (For injection procedure, see 61000-61070, 62270-62294)

           Cerebrospinal fluid flow, imaging (not including introduction of material); shunt
 78645                                                                                           0403     0403      S       S       $240.91       $263.15        9.23%
           evaluation (For injection procedure, see 61000-61070, 62270-62294)

           Cerebrospinal fluid flow, imaging (not including introduction of material);
 78647                                                                                           0402     0402      S       S       $607.69       $476.99       -21.51%
           tomographic (SPECT)

 78650     Cerebrospinal fluid leakage detection and localization                                0402     0402      S       S       $607.69       $476.99       -21.51%
 78660     Radiopharmaceutical dacryocystography                                                 0403     0403      S       S       $240.91       $263.15        9.23%
 78699     Unlisted nervous system procedure, diagnostic nuclear medicine                        0403     0403      S       S       $240.91       $263.15        9.23%
 78700     Kidney imaging morphology                                                             0404     0404      S       S       $318.82       $332.73        4.36%
 78701     Kidney imaging morphology with vascular flow                                          0404     0404      S       S       $318.82       $332.73        4.36%
           Kidney imaging morphology with vascular flow and function, single study                                                                $332.73
 78707                                                                                           0404     0404      S       S       $318.82                      4.36%
           without pharmacological intervention
           Kidney imaging morphology with vascular flow and function, single study, with
 78708     pharmacological intervention (eg, angiotensin converting enzyme inhibitor             0404     0404      S       S       $318.82       $332.73        4.36%
           and/or diuretic)
           Kidney imaging morphology with vascular flow and function, multiple studies,
 78709     with and without pharmacological intervention (eg, angiotensin converting             0404     0404      S       S       $318.82       $332.73        4.36%
           enzyme inhibitor and/or diuretic)
 78710     Kidney imaging morphology tomographic (SPECT)                                         0404     0404      S       S       $318.82       $332.73       4.36%
 78725     Kidney function study, non-imaging radioisotopic study                                0392     0392      S       S       $160.28       $197.86       23.45%
        Urinary bladder residual study (List separately in addition to code for primary
        procedure) (Use 78730 in conjunction with 78740) (For measurement of
78730 + postvoid residual urine and/or bladder capacity by ultrasound, nonimaging,               0389     0389      S       S       $109.01       $115.47        5.93%
        use 51798) (For ultrasound imaging of the bladder only, with measurement of
        postvoid residual urine when performed, use 76857)

           Ureteral reflux study (radiopharmaceutical voiding cystogram) For                                                                      $332.73
 78740                                                                                           0404     0404      S       S       $318.82                      4.36%
           catheterization see 51701, 51702, 51703
 78761     Testicular imaging with vascular flow                                                 0404     0404      S       S       $318.82       $332.73        4.36%
 78799     Unlisted genitourinary procedure; diagnostic nuclear medicine                         0404     0404      S       S       $318.82       $332.73        4.36%
           Radiopharmaceutical localization of tumor or distribution of
 78800                                                                                           0406     0406      S       S       $280.44       $300.86        7.28%
           radiopharmaceutical agent(s); limited area
           Radiopharmaceutical localization of tumor or distribution of
 78801                                                                                           0414     0414      S       S       $494.76       $507.39        2.55%
           radiopharmaceutical agent(s); multiple areas
           Radiopharmaceutical localization of tumor or distribution of
 78802                                                                                           0414     0414      S       S       $494.76       $507.39        2.55%
           radiopharmaceutical agent(s); whole body, single day imaging
           Radiopharmaceutical localization of tumor or distribution of
 78803                                                                                           0414     0414      S       S       $494.76       $507.39        2.55%
           radiopharmaceutical agent(s); tomographic (SPECT)

           Radiopharmaceutical localization of tumor or distribution of
 78804                                                                                           0408     0408      S       S       $957.47       $975.89        1.92%
           radiopharmaceutical agent(s); whole body, requiring 2 or more days imaging

 78805     Radiopharmaceutical localization of inflammatory process; limited area                0414     0414      S       S       $494.76       $507.39        2.55%

 78806     Radiopharmaceutical localization of inflammatory process; whole body                  0414     0414      S       S       $494.76       $507.39        2.55%

           Radiopharmaceutical localization of inflammatory process; tomographic
 78807     (SPECT) (For imaging bone infectious or inflammatory disease with a bone              0414     0414      S       S       $494.76       $507.39        2.55%
           imaging radiopharmaceutical, see 78300, 78305, 78306)
           Injection procedure for radiopharmaceutical localization by non-imaging probe
 78808     study, intravenous (eg, parathyroid adenoma)                                          0392     0392     Q1       Q1      $160.28       $197.86       23.45%
           (For sentinel lymph node identification, use 38792)
           Positron emission tomography (PET) imaging; limited area (eg. chest,                                                                  $1,058.20
 78811                                                                                           0308     0308      S       S      $1,038.06                     1.94%
           head/neck)
 78812     Positron emission tomography (PET) imaging; skull base to mid-thigh                   0308     0308      S       S      $1,038.06     $1,058.20       1.94%

 78813     Positron emission tomography (PET) imaging; whole body                                0308     0308      S       S      $1,038.06     $1,058.20       1.94%
           Positron emission tomography (PET) with concurrently acquired computed
 78814     tomography (CT) for attenuation correction and anatomical localization                0308     0308      S       S      $1,038.06     $1,058.20       1.94%
           imaging; limited area (eg, chest, head/neck)
           Positron emission tomography (PET) with concurrently acquired computed
 78815     tomography (CT) for attenuation correction and anatomical localization              0308   0308      S          S       $1,038.06     $1,058.20       1.94%
           imaging; skull base to mid-thigh
           Positron emission tomography (PET) with concurrently acquired computed
  78816 tomography (CT) for attenuation correction and anatomical localization                 0308   0308      S          S       $1,038.06     $1,058.20       1.94%
           imaging; whole body
(Report 78811-78816 only once per imaging session) (Computed tomography (CT) performed for other than attenuation correction
and anatomical localization is reported using the appropriate site specific CT code with modifier 59)

 78999     Unlisted miscellaneous procedure, diagnostic nuclear medicine                         0389     0389      S        S      $109.01       $115.47        5.93%

  C9898    Radiolabeled product provided during a hospital inpatient stay                                                          Packaged      Packaged
                                                                                                                                   into APC      into APC
           Radiopharmaceutical therapy, by oral administration (For monoclonal
 79005                                                                                           0407     407       S        S      $230.64       $237.30        2.89%
           antibody by intravenous infusion, use 79403)
           Radiopharmaceutical therapy, by intravenous administration (Do not report
           79101 in conjunction with 36400, 35410, 79403, 90780, 96408) (For
 79101     monoclonal antibody by intravenous infusion, use 79403) (For infusion or              0407     0407      S        S      $230.64       $237.30        2.89%
           instillation of non-antibody radioelement solution that includes three months
           follow-up care, use 77750)
 79200     Radiopharmaceutical therapy, by intracavitary administration                          0413     0413      S       S       $282.68       $296.17        4.77%

 79300     Radiopharmaceutical therapy, by interstitial radioactive colloid administration       0407     0407      S       S       $230.64       $237.30        2.89%

           Radiopharmaceutical therapy, radiolabeled monoclonal antibody by
 79403     intravenous infusion (For pre-treatment imaging, see 78802, 78804) (Do not            0413     0413      S        S      $282.68       $296.17        4.77%
           use in conjunction with 79101)
 79440     Radiopharmaceutical therapy, by intra-articular administration                        0413     0413      S       S       $282.68       $296.17        4.77%
           Radiopharmaceutical therapy, by intra-arterial particulate administration (Do
           not report 79445 in conjunction with 90783, 96420) (Use appropriate
 79445     procedural and radiological supervision and interpretation codes for the              0407     0407      S        S      $230.64       $237.30        2.89%
           angiographic and interventional procedures provided pre-requisite to intra-
           arterial radiopharmaceutical therapy)
 79999     Radiopharmaceutical therapy, unlisted procedure                                       0407     0407      S       S       $230.64       $237.30        2.89%
           Cardiovascular stress test using maximal or submaximal treadmill or bicycle
 93017     exercise, continuous electrocardiographic monitoring, and/or pharmacological          0100     0100      X        X      $178.11       $177.76       -0.20%
           stress; tracing only, without interpretation and report
           Chemotherapy administration, intravenous infusion technique; up to one hour,
 96413                                                                                           0440     0440      S        S      $207.80       $230.81       11.07%
           single or initial substance/drug
 G0219     PET imaging whole body; melanoma for non-covered indications                                             E        E
 G0235     PET IMAGING, ANY SITE, NOT OTHERWISE SPECIFIED                                                           E        E
           PET imaging, full & partial-ring PET scanner only, for initial diagnosis of breast
 G0252     cancer and/or surgical planning for breast cancer (eg, initial staging of axillary                       E        E
           lymph nodes)

                 RADIOPHARMACEUTICALS & NUCLEAR MEDICINE RELATED DRUGS                                                              CY 2012       CY 2013
                                                                                                                    SI      SI       FINAL       PROPOSED
                                                                                                                                                                % Change

           Radiopharm dx agent noc                                                                                                 Packaged
 A4641                                                                                                              N        N                    Packaged
           RADIOPHARMACEUTICAL, DIAGNOSTIC, NOT                                                                                    into APC
                                                                                                                                                into APC rate
           OTHERWISE CLASSIFIED                                                                                                       rate
           In111 satumomab
                                                                                                                                   Packaged
           INDIUM IN-111 SATUMOMAB PENDETIDE, DIAGNOSTIC,                     ONCOSCINT                                                           Packaged
 A4642                                                                                                              N        N     into APC
           PER STUDY DOSE, UP TO 6 MILLICURIES                                    ®                                                             into APC rate
                                                                                                                                      rate




                           Revision Date: July 6, 2012                                                                                                                     SNM Reimbursement Hospital Educational Material                                      Page 2 of 4
                           CPT codes copyright by the AMA                                                                                                                                www.snm.org                         Prepared by Merlino Healthcare Consulting Corp.
                                                                                                                                                                                                                                                   WWW.SNM.ORG




                                                                                                                        2013-   FINAL RULE    PROPOSED
CPT/                                                                         Trade           2012-F   2013-P   2012-F
                                                                                                                          P       CY 2012    RULE CY 2013
                                                                                                                                                               %

                                                                                                                                 Payment
HCPCS                          Description                                   Name             APC      APC       SI      SI
                                                                                                                                   Rate
                                                                                                                                             Payment Rate Change

        Tc99m sestamibi                                                        CARDIOLITE                                       Packaged
        Injection procedure; radioactive tracer for identification of sentinel node                                                            Packaged
A9500   TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER                                ®/                           N        N     into APC
        STUDY DOSE, UP TO 40 MILLICURIES                                                                                                     into APC rate
                                                                               MIRALUMA®                                           rate
        Technetium TC-99m teboroxime
                                                                                                                                Packaged
        TECHNETIUM TC-99M TEBOROXIME, DIAGNOSTIC, PER                      CardioTec®                                                          Packaged
A9501                                                                                                            N        N     into APC
        STUDY DOSE                                                           TEBO                                                            into APC rate
                                                                                                                                   rate
        Tc99m tetrofosmin                                                                                                       Packaged
A9502                                                                                                            N        N                    Packaged
        TECHNETIUM TC-99M TETROFOSMIN, DIAGNOSTIC,                         MYOVIEW®                                             into APC
                                                                                                                                             into APC rate
        PER STUDY DOSE                                                                                                             rate
        Tc99m medronate
                                                                                                                                Packaged
                                                                                                                                               Packaged
A9503                                                                          MDP                               N        N     into APC
        TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER                                                                                         into APC rate
                                                                                                                                   rate
        STUDY DOSE, UP TO 30 MILLICURIES
        Tc99m apcitide
                                                                                                                                Packaged
A9504                                                                                                            N        N                    Packaged
                                                                           ACUTECT®                                             into APC
        TECHNETIUM TC-99M APCITIDE, DIAGNOSTIC, PER                                                                                          into APC rate
                                                                                                                                   rate
        STUDY DOSE, UP TO 20 MILLICURIES
        TL201 thallium
                                                                                                                                Packaged
                                                                           THALLIUM                                                            Packaged
A9505                                                                                                            N        N     into APC
        THALLIUM TL-201 THALLOUS CHLORIDE, DIAGNOSTIC,                       201                                                             into APC rate
                                                                                                                                   rate
        PER MILLICURIE
        In111 capromab
                                                                                                                                Packaged
A9507                                                                     PROSTASCINT®                           N        N                    Packaged
                                                                                                                                into APC
        INDIUM IN-111 CAPROMAB PENDETIDE, DIAGNOSTIC,                                                                                        into APC rate
                                                                                                                                   rate
        PER STUDY DOSE, UP TO 10 MILLICURIES
        I131 iodobenguate, dx                                                                                                   Packaged
                                                                                                                                               Packaged
A9508                                                                      I-131 MIBG                            N        N     into APC
                                                                                                                                             into APC rate
        IODINE I-131 IOBENGUANE SULFATE, DIAGNOSTIC,                                                                               rate
        Iodine I-123 sod iodide mil                                         Use for 1-4
                                                                          mCi doses of I-                                       Packaged
                                                                          123 for whole                                                        Packaged
A9509   IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER                                                              N        N     into APC
                                                                           body imaging                                                      into APC rate
        MILLICURIE                                                                                                                 rate
                                                                          for less than 1
                                                                             mCi and
        Tc99m disofenin
                                                                                                                                Packaged
                                                                                                                                               Packaged
A9510                                                                        DISIDA                              N        N     into APC
        TECHNETIUM TC-99M DISOFENIN, DIAGNOSTIC, PER                                                                                         into APC rate
                                                                                                                                   rate
        STUDY DOSE, UP TO 15 MILLICURIES
                                                                         Straight Tech                                          Packaged
        Tc99m pertechnetate         TECHNETIUM TC-                                                                                             Packaged
A9512                                                                     Technescan                             N        N     into APC
        99M PERTECHNETATE, DIAGNOSTIC, PER MILLICURIE                                                                                        into APC rate
                                                                           Technelite                                              rate
                                                                            Dx I-123
                                                                         Capsules. Use
        Iodine I-123 sod iodide mCi
                                                                         for A9516 for                                          Packaged
        IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER 100                                                                                        Packaged
A9516                                                                       Thyroid                              N        N     into APC
        MICROCURIES, UP TO 999 MICROCURIES                                                                                                   into APC rate
                                                                          uptakes and                                              rate
                                                                          scans, for 1
                                                                            mCi and
        I131 iodide cap, rx                                               greater and
A9517                                                                       Rx I-131          1064               K        K                                  3.82%
        IODINE I-131 SODIUM IODIDE CAPSULE(S),                                                         1064                      $17.26         $17.92
                                                                           Capsules
        THERAPEUTIC, PER MILLICURIE
        Tc99m exametazime
                                                                                                                                Packaged
                                                                           CERETEC®                                                            Packaged
A9521                                                                                                            N        N     into APC
        TECHNETIUM TC-99M EXAMETAZIME, DIAGNOSTIC,                          HMPAO                                                            into APC rate
                                                                                                                                   rate
        PER STUDY DOSE, UP TO 25 MILLICURIES
        I131 serum albumin, dx          IODINE I-131                                                                            Packaged
A9524                                                                                                            N        N                    Packaged
        IODINATED SERUM ALBUMIN, DIAGNOSTIC, PER 5       I-131 Albumin                                                          into APC
                                                                                                                                             into APC rate
        MICROCURIES                                                                                                                rate
        Nitrogen N-13 ammonia                                                                                                   Packaged
A9526                                                          N-13                                              N        N                    Packaged
        NITROGEN N-13 AMMONIA, DIAGNOSTIC, PER STUDY                                                                            into APC
                                                                                                                                             into APC rate
        DOSE, UP TO 40 MILLICURIES                                                                                                 rate
        Iodine I-125 sodium iodide
A9527   IODINE I-125, SODIUM IODIDE SOLUTION,                                                 2632     2632      U        U      $16.83         $20.86       23.95%
        THERAPEUTIC, PER MILLICURIE
        Iodine I-131 iodide cap, dx                                                                                             Packaged
A9528                                                    I-131 Dx caps                                           N        N                    Packaged
        IODINE I-131 SODIUM IODIDE CAPSULE(S),                                                                                  into APC
                                                            per mCi                                                                          into APC rate
        DIAGNOSTIC, PER MILLICURIE                                                                                                 rate
        I131 iodide sol, dx                                                                                                     Packaged
A9529                                                      Dx I-131 sol                                          N        N                    Packaged
        IODINE I-131 SODIUM IODIDE SOLUTION, DIAGNOSTIC,                                                                        into APC
                                                            per mCi                                                                          into APC rate
        PER MILLICURIE                                                                                                             rate
        I131 iodide sol, rx
A9530                                                      Rx I-131 sol                       1150               K        K                                  6.77%
        IODINE I-131 SODIUM IODIDE SOLUTION,                                                           1150                      $10.49         $11.20
                                                            per mCi
        THERAPEUTIC, PER MILLICURIE
        I131 max 100uCi                                                                                                         Packaged
A9531                                                    Dx I-131 up to                                          N        N                    Packaged
        IODINE I-131 SODIUM IODIDE, DIAGNOSTIC, PER                                                                             into APC
                                                            100 uCi                                                                          into APC rate
        MICROCURIE (UP TO 100 MICROCURIES)                                                                                         rate
        I125 serum albumin, dx                                                                                                  Packaged
A9532                                                                                                            N        N                    Packaged
        IODINE I-125 SERUM ALBUMIN, DIAGNOSTIC, PER 5                                                                           into APC
                                                                                                                                             into APC rate
        MICROCURIES                                                                                                                rate
        Tc99m depreotide
                                                                                                                                Packaged
        TECHNETIUM TC-99M DEPREOTIDE, DIAGNOSTIC, PER                                                                                          Packaged
A9536                                                      NEOTEC®                                               N        N     into APC
        STUDY DOSE, UP TO 35 MILLICURIES                                                                                                     into APC rate
                                                                                                                                   rate
        Tc99m mebrofenin
                                                                                                                                Packaged
A9537   TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER                                                            N        N                    Packaged
                                                      CHOLETEC®                                                                 into APC
        STUDY DOSE, UP TO 15 MILLICURIES                                                                                                     into APC rate
                                                                                                                                   rate
                                                                            PYROLITE®
                                                                           *Use this code
        Tc99m pyrophosphate                                                for myocardial
                                                                                                                                Packaged
        TECHNETIUM TC-99M PYROPHOSPHATE, DIAGNOSTIC,                      infarct imaging.                                                     Packaged
A9538                                                                     Do not use this
                                                                                                                 N        N     into APC
        PER STUDY DOSE, UP TO 25 MILLICURIES                                                                                                 into APC rate
                                                                           code for GBP,                                           rate
                                                                          RVG or MUGA
                                                                          procedures see
        Tc99m pentetate                                                        A9560
                                                                                                                                Packaged
A9539                                                                                                            N        N                    Packaged
                                                                          Tc-99m DTPA                                           into APC
        TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER                                                                                         into APC rate
                                                                                                                                   rate
        STUDY DOSE, UP TO 25 MILLICURIES
        Tc99m MAA
                                                                                                                                Packaged
A9540                                                                                                            N        N                    Packaged
        TECHNETIUM TC-99M MACROAGGREGATED ALBUMIN,                             MAA                                              into APC
                                                                                                                                             into APC rate
        DIAGNOSTIC, PER STUDY DOSE, UP TO 10                                                                                       rate
        MILLICURIES
        Tc99m sulfur colloid
                                                                            SULFUR                                              Packaged
                                                                                                                                               Packaged
A9541   TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC,                      COLLOID®                              N        N     into APC
                                                                                                                                             into APC rate
        PER STUDY DOSE, UP TO 20 MILLICURIES                                 (SC)                                                  rate

        In111 ibritumomab, dx
                                                                                                                                Packaged
                                                                           Dx In-111                                                           Packaged
A9542                                                                                                            N        N     into APC
        INDIUM IN-111 IBRITUMOMAB TIUXETAN, DIAGNOSTIC,                    ZEVALIN®                                                          into APC rate
                                                                                                                                   rate
        PER STUDY DOSE, UP TO 5 MILLICURIES
        Y90 ibritumomab, rx

        YTTRIUM Y-90 IBRITUMOMAB TIUXETAN,                                  Rx Y-90
A9543                                                                                         1643     1643      K        K     $36,100.41    $36,612.79     1.42%
        THERAPEUTIC, PER TREATMENT DOSE, UP TO 40                          ZEVALIN®
        MILLICURIES
        I131 tositumomab, dx
                                                                                                                                Packaged
                                                                                                                                               Packaged
A9544                                                                     Dx BEXXAR®                             N        N     into APC
        IODINE I-131 TOSITUMOMAB, DIAGNOSTIC, PER STUDY                                                                                      into APC rate
                                                                                                                                   rate
        DOSE
        I131 tositumomab, rx
A9545                                                                     Rx BEXXAR®          1645     1645      K        K     $29,618.96    $30,188.56     1.92%
        IODINE I-131 TOSITUMOMAB, THERAPEUTIC, PER
        TREATMENT DOSE
        Co57/58
                                                                                                                                Packaged
A9546                                                                      NYCOMED                               N        N                    Packaged
        COBALT CO-57/58, CYANOCOBALAMIN, DIAGNOSTIC,                                                                            into APC
                                                                                                                                             into APC rate
        PER STUDY DOSE, UP TO 1 MICROCURIE                                                                                         rate

        In111 oxyquinoline                                                See new codes
                                                                            A9570 and                                           Packaged
        INDIUM IN-111 OXYQUINOLINE, DIAGNOSTIC, PER 0.5                                                                                        Packaged
A9547                                                                     A9571 for WBC                          N        N     into APC
        MILLICURIE                                                                                                                           into APC rate
                                                                           and Platelet                                            rate
                                                                             Imaging
        In111 pentetate                                                                                                         Packaged
        INDIUM IN-111 PENTETATE, DIAGNOSTIC, PER 0.5                                                                                           Packaged
A9548                                                                     Indium DTPA                            N        N     into APC
        MILLICURIE                                                                                                                           into APC rate
                                                                                                                                   rate
        Tc99m gluceptate
                                                                                                                                Packaged
        TECHNETIUM TC-99M SODIUM GLUCEPTATE,                                                                                                   Packaged
A9550                                                                     GLUCOSCAN®                             N        N     into APC
        DIAGNOSTIC, PER STUDY DOSE, UP TO 25                                                                                                 into APC rate
                                                                                                                                   rate
        MILLICURIES
        Tc99m succimer
                                                                                                                                Packaged
        TECHNETIUM TC-99M SUCCIMER, DIAGNOSTIC, PER                                                                                            Packaged
A9551                                                                         DMSA                               N        N     into APC
        STUDY DOSE, UP TO 10 MILLICURIES                                                                                                     into APC rate
                                                                                                                                   rate
        F18 fdg                                                                                                                 Packaged
        FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER                                                                                           Packaged
A9552                                                                      FDG / F-18                            N        N     into APC
        STUDY DOSE, UP TO 45 MILLICURIES                                                                                                     into APC rate
                                                                                                                                   rate

        Cr51 chromate
                                                                                                                                Packaged
A9553   CHROMIUM CR-51 SODIUM CHROMATE, DIAGNOSTIC,                                                              N        N                    Packaged
                                                                                                                                into APC
        PER STUDY DOSE, UP TO 250 MICROCURIES                                                                                                into APC rate
                                                                                                                                   rate

        I125 iothalamate, dx
                                                                                                                                Packaged
        IODINE I-125 SODIUM IOTHALAMATE, DIAGNOSTIC,                                                                                           Packaged
A9554                                                                                                            N        N     into APC
        PER STUDY DOSE, UP TO 10 MICROCURIES                                                                                                 into APC rate
                                                                                                                                   rate
        Rb82 rubidium                                                                                                           Packaged
                                                                             Rb-82                                                             Packaged
A9555                                                                                                            N        N     into APC
                                                                          CardioGen82                                                        into APC rate
        RUBIDIUM RB-82, DIAGNOSTIC, PER STUDY DOSE, UP                                                                             rate
        TO 60gallium
        Ga67 MILLICURIES                                                                                                        Packaged
A9556                                                                       GALLIUM                              N        N                    Packaged
        GALLIUM GA-67 CITRATE, DIAGNOSTIC, PER                                                                                  into APC
                                                                                                                                             into APC rate
        MILLICURIE                                                                                                                 rate
        Tc99m bicisate
                                                                                                                                Packaged
        TECHNETIUM TC-99M BICISATE, DIAGNOSTIC, PER                                                                                            Packaged
A9557                                                                     NEUROLITE®                             N        N     into APC
        STUDY DOSE, UP TO 25 MILLICURIES                                                                                                     into APC rate
                                                                                                                                   rate
        Xe133 xenon 10mci                                                                                                       Packaged
        XENON XE-133 GAS, DIAGNOSTIC, PER 10                                                                                                   Packaged
A9558                                                                         Xenon                              N        N     into APC
        MILLICURIES                                                                                                                          into APC rate
                                                                                                                                   rate
        Co57 cyano
                                                       Shillings Study                                                          Packaged
A9559   COBALT CO-57 CYANOCOBALAMIN, ORAL,                                                                       N        N                    Packaged
                                                       Rubratope 57                                                             into APC
        DIAGNOSTIC, PER STUDY DOSE, UP TO 1 MICROCURIE                                                                                       into APC rate
                                                       Cobatope 57                                                                 rate

                                                                         ULTRATAG® or
        Tc99m labeled rbc                                                Cold PYP + 99m
        TECHNETIUM TC-99M LABELED RED BLOOD CELLS,                        Tc Code to be                                         Packaged
A9560                                                                    used for both the                       N        N                    Packaged
        DIAGNOSTIC, PER STUDY DOSE, UP TO 30                                                                                    into APC
                                                                           invivo/invitro                                                    into APC rate
        MILLICURIES                                                                                                                rate
                                                                            methods of
                                                                           tagging Red
                                                                            Blood Cells
        Tc99m oxidronate
                                                                                                                                Packaged
        TECHNETIUM TC-99M OXIDRONATE, DIAGNOSTIC, PER                                                                                          Packaged
A9561                                                                         HDP®                               N        N     into APC
        STUDY DOSE, UP TO 30 MILLICURIES                                                                                                     into APC rate
                                                                                                                                   rate

        Tc99m mertiatide
                                                                                                                                Packaged
A9562   TECHNETIUM TC-99M MERTIATIDE, DIAGNOSTIC, PER                                                            N        N                    Packaged
                                                                             MAG-3®                                             into APC
        STUDY DOSE, UP TO 15 MILLICURIES                                                                                                     into APC rate
                                                                                                                                   rate
        P32 Na phosphate
A9563   SODIUM PHOSPHATE P-32, THERAPEUTIC, PER                                               1675               K        K                                  41.39%
                                                                                                       1675                      $126.14       $178.35
        MILLICURIE




                        Revision Date: July 6, 2012                                                                                                                   SNM Reimbursement Hospital Educational Material                                      Page 3 of 4
                        CPT codes copyright by the AMA                                                                                                                              www.snm.org                         Prepared by Merlino Healthcare Consulting Corp.
                                                                                                                                                                                                                                                                    WWW.SNM.ORG




                                                                                                                                     2013-   FINAL RULE       PROPOSED
 CPT/                                                                                 Trade         2012-F         2013-P   2012-F
                                                                                                                                       P       CY 2012       RULE CY 2013
                                                                                                                                                                               %

                                                                                                                                              Payment
HCPCS                               Description                                       Name             APC          APC       SI      SI
                                                                                                                                                Rate
                                                                                                                                                             Payment Rate Change

           P32 chromic phosphate
           Injection procedure; radioactive tracer for identification of sentinel node
                                                                                   Phosphocol
 A9564     CHROMIC PHOSPHATE P-32 SUSPENSION,                                                          1676         1676      K        K       $579.98          $56.16       -90.32%
           THERAPEUTIC, PER MILLICURIE                                                 P-32

           Tc99m fanolesomab
                                                                                                                                              Packaged
           TECHNETIUM TC-99M FANOLESOMAB, DIAGNOSTIC,                                                                                                          Packaged
 A9566                                                                             NeutroSpec™                                N        N      into APC
           PER STUDY DOSE, UP TO 25 MILLICURIES                                                                                                              into APC rate
                                                                                                                                                 rate

           Technetium TC-99m aerosol                                               DTPA Aerosol
                                                                                                                                              Packaged
 A9567     TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC,                                  For Lung                                 N        N                       Packaged
                                                                                                                                              into APC
           AEROSOL, PER STUDY DOSE, UP TO 75 MILLICURIES                            Ventilation                                                              into APC rate
                                                                                                                                                 rate
                                                                                     Studies

           Technetium tc99m arcitumomab                                                                                                       Packaged
                                                                                                                                                               Packaged
 A9568     TECHNETIUM TC-99M ARCITUMOMAB, DIAGNOSTIC,                              CEA-SCAN®                                  N        N      into APC
                                                                                                                                                             into APC rate
           PER STUDY DOSE, UP TO 45 MILLICURIES                                                                                                  rate

           Technetium TC-99m auto WBC                     Use this code
           TECHNETIUM TC-99M EXAMETAZIME LABELED         for infection or                                                                     Packaged
                                                          inflammation                                                                                         Packaged
 A9569     AUTOLOGOUS WHITE BLOOD CELLS, DIAGNOSTIC,                                                                          N        N      into APC
                                                         imaging do not                                                                                      into APC rate
           PER STUDY DOSE                                                                                                                        rate
                                                          use this code
                                                             for brain
           Indium In-111 auto WBC                             When
                                                                                                                                              Packaged
 A9570     'INDIUM IN-111 LABELED AUTOLOGOUS WHITE BLOOD prepared with                                                        N        N                       Packaged
                                                          patient WBC                                                                         into APC
           CELLS, DIAGNOSTIC, PER STUDY DOSE                                                                                                                 into APC rate
                                                          use this new                                                                           rate
                                                           code do not
           Indium IN-111 auto platelet                        When
                                                                                                                                              Packaged
           INDIUM IN-111 LABELED AUTOLOGOUS PLATELETS,    prepared with                                                                                        Packaged
 A9571                                                                                                                        N        N      into APC
           DIAGNOSTIC, PER STUDY DOSE                         patient                                                                                        into APC rate
                                                                                                                                                 rate
                                                          platelets use
 A9572     Indium In-111 pentetreotide                                             Octreoscan®
                                                                                                                                              Packaged
  CMS      'INDIUM IN-111 PENTETREOTIDE, DIAGNOSTIC, PER                            A9565 was                                 N        N                       Packaged
                                                                                                                                              into APC
 deleted   STUDY DOSE, UP TO 6 MILLICURIES                                             deleted                                                               into APC rate
                                                                                                                                                 rate
 A9565                                                                             effective 2008

           Sodium Fluoride F-18,                                                    F-18, NaF,                                                Packaged
                                                                                                                              N        N                       Packaged
 A9580     Sodium Fluoride F-18, diagnostic, per study dose, up to 30                Sodium                                                   into APC
                                                                                                                                                             into APC rate
           millicuries                                                               Fluoride                                                    rate

           Iobenguane, I-123, diagnostic, per study dose, up to 15                 I-123 MIBG       Removed from                              Packaged         Packaged
 A9582                                                                               AdreView       Pass-through              N        N      into APC
           millicuries                                                                                  2012                                                 into APC rate
                                                                                   NDC 17156-                                                    rate
           Sr89 strontium
                                                                                       Rx
 A9600     STRONTIUM SR-89 CHLORIDE, THERAPEUTIC, PER                                                  0701                   K        K                                     2.34%
                                                                                   METASTRON                        0701                       $954.77         $977.14
           MILLICURIE
                                                                                       ®

           Sm 153 lexidronm
                                                                                       Rx
 A9604     SAMARIUM SM-153 LEXIDRONAMM, THERAPEUTIC,                                                   1295                   K        K                                     1.92%
                                                                                   QUADRAMET                        1295                      $7,592.00       $7,738.00
           PER TREATMENT DOSE, up to 150 MILLICURIES
                                                                                       ®

           Radiopharm rx agent noc
                                                                                                                                              Packaged
           RADIOPHARMACEUTICAL, THERAPEUTIC, NOT                                                                                                               Packaged
 A9699                                                                               RX NOC                                   N        N      into APC
           OTHERWISE CLASSIFIED                                                                                                                              into APC rate
                                                                                                                                                 rate
                                                                                   DaTscan® NDC
lA9584 Iodine I-123 ioflupane, diagnostic, per study dose, (up to 5 millicuries)    #17156-210-01
                                                                                                       9406         9406      G        G     $1,908.00 $1,905.21             -0.15%
**Note final payment rates for status G codes have offset RP amounts posted on the CMS web site by CPT code.
           Injection adenosine 6 mg
           Injection Adenosine for therapeutic use, 6 mg (not to be used                                                                      Packaged
                                                                                                                                                               Packaged
 J0150     to report any adenosine phosphate compounds, instead use ADENOCARD                                                CH N      N      into APC
                                                                                                                                                             into APC rate
           A9270)                                                                                                                                rate

           Adenosine injection, 30 mg
 J0152     Injection Adenosine for diagnostic use, 30 mg (not to be used ADENOSCAN                     0917                   K        K                                     11.27%
                                                                                                                    0917                       $94.42         $105.06
           to report any adenosine phosphate compounds, instead use
           A9270)
                                                                                                                                             Packaged into   Packaged into
 J0280     Aminophyllin up to 250 MG, inj.                                                                                    N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J0461     Inj, atropine sulfate, 0.01 mg                                                                                     N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J1120     Acetazolamide sodium injection, up to 500 mg                               Diamox                                  N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J1160     Inj, digoxin, up to 0.5 mg                                                 Lanoxin                                 N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J1245     Dipyridamole injection, per 10mg                                        Persantine IV                              N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J1250     Inj dobutamine HCL/250 mg                                                 Dobutrex                                 N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J1265                                                                                Intropin                                N        N
                                                                                                                                               APC rate        APC rate
 J1610     Glucagon hydrochloride per 1MG                                            Glucagen          9042         9042      K        K       $101.30         $110.77       9.35%
                                                                                                                                             Packaged into   Packaged into
 J1800     Propranolol HCL injection, up to 1 mg                                       Inderal                                N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J1940     Furosemide injection up to 20 mg                                            Lasix                                  N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J2270     Morphine sulfate injection, up to 10 mg                                                                            N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J2271     Morphine sulfate injection, 100 mg                                                                                 N        N
                                                                                                                                               APC rate        APC rate
                                                                                    LexiScan NDC
 J2785     Injection, Regadenoson, 0.1 milligrams                                                      9244         9244      K        K       $51.22           $52.65       2.79%
                                                                                    00469-6501-89
           Sincalide injection                                                                                                               Packaged into   Packaged into
 J2805                                                                               Kinevac®                                 N        N
           INJECTION, SINCALIDE, 5 MICROGRAMS                                                                                                  APC rate        APC rate

 J3240                                                                               Thyrogen          9108                   K        K                      $1,053.29      2.04%
           Thyrotropin injection 0.9 mg n 1.1 mg vial                                                               9108                      $1,032.25
                                                                                     Thytropar
                                                                                                                                             Packaged into   Packaged into
 J3420     Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg                                                             N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J3490     Drugs Unclassified injection                                                 NOC                                   N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J3590     Unclassified biologics                                                       NOC                                   N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J7030     Normal saline solution infus (1000 CC)                                                                             N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J7040     Normal saline solution infus (500ML=1)                                                                             N        N
                                                                                                                                               APC rate        APC rate
                                                                                                                                             Packaged into   Packaged into
 J7050     Normal saline solution infus (250 CC)                                                                              N        N
                                                                                                                                               APC rate        APC rate
 J9310     Rituximab, 100 mg                                                          RituXan          0849         0849      K        K       $615.22         $641.95       4.34%

 G3001     Admin + supply, tositumomab, 450 mg                                         Non             0442                   S        S                      $2,013.44      30.80%
                                                                                                                    0442                      $1,539.30
           (Use this Code for Bexxar)                                               Radioactive

 Q9968     Injection, non-radioactive, non-contrast, visualization adjunct         Methylene Blue       N/A         N/A      Ch N      N     Packaged into   Packaged into
           (e.g., Methylene Blue, Isosulfan Blue), 1mg                                                                                         APC rate        APC rate




                             Revision Date: July 6, 2012                                                                                                                               SNM Reimbursement Hospital Educational Material                                      Page 4 of 4
                             CPT codes copyright by the AMA                                                                                                                                          www.snm.org                         Prepared by Merlino Healthcare Consulting Corp.

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:37
posted:8/31/2012
language:Unknown
pages:4