2012 Medicare Reimbursement Information Lantheus Medical Imaging
Reimbursement consists of three elements: Coding, coverage and payment. Coding: There must be a CPT® code or 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 guarantee 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 Determinations.
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. Most payment amounts are determined by CMS nationally. There are differences in procedure payment amounts from region to region to reflect geographic differences in provider costs.
Documentation: When radiopharmaceuticals or contrast agents are reported providers must document in the medical record the name of the drug and the amount administered.
Lantheus Medical Imaging, Inc. cannot guarantee coverage or payment for products or procedures. Payer policies can vary widely. For more specific information contact the payer directly in order to obtain up to date coverage, coding and payment information.
For the full Definity documentation, please see the attached document.
Optison For Your Lab
Optison is conveniently packaged in 3-mL vials for single-patient use, with five 3-mL vials per box. To place an order for Optison, please call GE Healthcare Customer Service at 800 292 8514 or contact your local GE Healthcare sales representative.
Reimbursement Information for Optison
Healthcare providers should use their best judgment in selecting the most appropriate codes to eflect the services that they provide to their patients. Please refer to the most current professional coding reference books or Medicare’s coding guidelines for additional information.
Physicians performing echocardiography studies using Optison should report the HCPCS code for the drug and the CPT® code(s) for the procedure(s). The corresponding HCPCS codes are as follows:
HCPCS Codes for Optison
Some payers also may require the NDC for the product on the claims form:
- NDC 0407-2707-03 Optison, 1 box, five 3-mL vials
All coding and reimbursement information is for reference purposes only. GE Healthcare does not guarantee payment. Use of information in this document does not ensure that you will successfully obtain insurance payment, as third-party reimbursement is affected by many variables.
If you have any questions regarding reimbursement for Optison, please call the GE Healthcare Reimbursement Hotline at 800 767 6664.
Optison™ (Perflutren Protein-Type A Microspheres Injectable Suspension, USP)
BOXED WARNING: Serious Cardiopulmonary Reactions: Serious cardiopulmonary reactions, including fatalities, have occurred during or following perflutren-containing microsphere administration. Assess all patients for the presence of any condition that precludes Optison administration. In patients with pulmonary hypertension or unstable cardiopulmonary conditions, monitor vital sign measurements, electrocardiography, and cutaneous oxygen saturation during and for at least 30 minutes after Optison administration. Always have resuscitation equipment and trained personnel readily available.
INDICATIONS: Optison is indicated for use in patients with suboptimal echocardiograms to opacify the left ventricle and to improve the delineation of the left ventricular endocardial borders. The safety and efficacy of Optison with exercise or pharmacologic stress testing have not been established. CONTRAINDICATIONS: Do not administer Optison to patients with known or suspected (1) Right-to-left, bi-directional, or transient right-to-left cardiac shunts, or (2) Hypersensitivity to perflutren, blood, blood products, or albumin. Do not administer Optison by intra-arterial injection.
Please click here to see more Important Risk and Safety Information.
Prior to using Optison, please read the Full Prescribing Information.
CPT is a registered trademark of the American Medical Association