Reimbursement
Reimbursement consists of three elements: Coding, coverage and payment.
Download 2011 Medicare Reimbursement Information
Coding: There must be a Current Procedural Terminology (CPT®) or Healthcare Common Procedure Coding System (HCPCS) code that accurately describes the service performed and/or the drugs provided.
Coverage: The existence of CPT and/or HCPCS codes used to report the services performed or items furnished does not mean there is guaranteed Medicare coverage for procedures, supplies or drugs.
Medicare only covers a procedure, drug or supply when it is medically necessary.
Providers should obtain and follow the policies and guidelines published by Medicare in the Local and National Coverage Decisions for echocardiography and nuclear cardiology.
Payment: If the proper codes exist and there is coverage established, Medicare must set a payment amount for the drugs, supplies and or procedures in order for providers to receive payment. Payment amounts are determined by CMS nationally. There are differences in payment amounts from region to region to reflect geographic differences in provider costs. Some payment amounts are set by the local contractors.
Documentation: When radiopharmaceuticals or contrast agents are billed providers must document in the medical record the name of the drug and the amount administered.
Payments listed are Medicare national average amounts.
If you have any questions about reimbursement related to DEFINITY®, please contact DEFINITY® Reimbursement Support at
1-800-362-2668 x7995 or via email.
Lantheus Medical Imaging cannot guarantee coverage or payment for products or procedures. Payer policies can widely vary and third party payment for medical products and services is affected by numerous factors. It is always the provider's responsibility to determine and submit appropriate codes, charges, and modifiers for services rendered. For more specific information, contact your third-party payer directly in order to obtain up-to-date coverage, coding and payment information.
INDICATIONS
Activated DEFINITY® (Perflutren Lipid Microsphere) Injectable Suspension is indicated for use in patients with suboptimal echocardiograms to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border.
CONTRAINDICATIONS
Do not administer DEFINITY® to patients with known or suspected right-to-left, bi-directional or transient right-to-left cardiac shunts, by intra-arterial injection, or to patients with known hypersensitivity to perflutren.
IMPORTANT SAFETY INFORMATION
WARNING: Serious Cardiopulmonary Reactions Serious cardiopulmonary reactions, including fatalities, have occurred uncommonly during or following perflutren-containing microsphere administration [See WARNINGS AND PRECAUTIONS (5.1)]. Most serious reactions occur within 30 minutes of administration.
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In post marketing use, rare but serious cardiopulmonary or anaphylactoid reactions have been reported during or shortly following perflutren-containing microsphere administration [See ADVERSE REACTIONS (6)]. The risk for these reactions may be increased among patients with unstable cardiopulmonary conditions [See Postmarketing Experience (6.2)]. It is not always possible to reliably establish a causal relationship to drug exposure due to the presence of underlying cardiopulmonary disease.
Please see full Prescribing Information, including boxed WARNING regarding serious cardiopulmonary reactions.
