- Category: Coding and Payment
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.