Reimbursement consists of three elements: Coding, coverage and payment.
Download 2017 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.