Are You Billing Your Radiopharmaceuticals Correctly?
Check the current HCPCS code description for radiopharmaceuticals. The code's description typically defines one unit of service.
Most radiopharmaceuticals that have their own code include in the code's description "per study dose" and include a range of mCi's. These radiopharmaceutical agents should be billed as one unit of service per study. It is not appropriate to bill per mCi for the HCPCS codes that include a "per study dose" in its description.
A9503 is defined as Technetium Tc 99m, Medronate, (MDP), diagnostic, per study dose, up to 30 mCi's. Per study dose, up to 30 millicuries is one unit of service. If the provider administers one to 30 mCi of this agent for a study, it should be billed as one unit of service.
It would be unusual to have more than two units of service for most of the agents with a "per study dose" in its HCPCS description.
Watch for an update to our RAD-026 LCD and Billing and Coding guideline in our August Communiqué.
Page Last Updated: Tuesday, 15-Jul-2008 10:45:20 CDT
