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Billing and Coding Guidelines for Radiopharmaceutical ...

Billing and Coding Guidelines for Radiopharmaceutical Agents (RAD-026) National Coverage Title XVIII of the Social Security Act section 1862(a) (1) (A). This section allows coverage and payment of those services that are considered medically reasonable and necessary. Title XVIII of the Social Security Act section 1862(a) (7). This section excludes routine physical examinations and services. Title XVIII of the Social Security Act section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Medicare Regulation Excerpts: PUB 100-4 Medicare Claims Processing Manual- Chapter 12 - Physicians/Nonphysician Practitioners - Supplies (Rev. 1, 10-01-03) Carriers make a separate payment for supplies furnished in connection with a procedure only when one of the two following conditions exists: The supply is a pharmaceutical or Radiopharmaceutical diagnostic imaging agent (including codes A4641 through A4647); pharmacologic stressing agent (code J1245); or therapeutic radionuclide (CPT code 79900).

TC RVUs); or • Therapeutic nuclear medicine procedures. Drugs are not supplies, and may be paid incidental to physicians’ services as described in Chapter 17. PUB 100-04 Medicare Claims Processing Manual- Chapter 17 Drugs and Biologicals . 90.2 - Drugs, Biologicals, and Radiopharmaceuticals

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