Two women looking at computer monitors.

Nuclear reimbursement resources

No, Medicare does not differentiate between SC and FSC. SC and FSC are reported with the same HCPCS code (A9541) and descriptor.

View source: CMS

Yes, the $10 add-on payment continues in calendar year 2020. Q9969 can be reported as an ‘add on’ HCPCS code for a Tc-99m dose derived from any non-HEU source

CMS final rule for 2020 allows hospitals to report HCPCS code Q9969 (Tc-99m from non-highly enriched uranium source, full cost recovery add-on per study dose) once per dose along with any diagnostic scan or scan furnished using Tc-99m as long as the TC-99m doses used can be certified by the hospital to be at least 95% derived from non-HEU sources.

View source: CMS

Private pay reimbursement information is non-public. Hospitals should consult with their internal billing department or directly with their contracted payers for more information.

LYMPHOSEEK? coding, coverage and payment

63KB – PDF

MUGA coding, coverage and payment

93KB – PDF

MPI coding, coverage and payment

103KB – PDF

Current list of FDA-approved radiopharmaceuticals

112KB – PDF

FDA-approved radiopharmaceuticals and contraindications

43KB – PDF