Coding and Reimbursement Q&A

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11/19/2023Billing Discarded (Wasted Drugs) i.e. Adenosine, or Radiopharmaceuticals JW & JZ ModifiersHow do we code and bill for adenosine when we do not use the entire vial on a Medicare patient? Also does this policy apply to radiopharmaceuticals or for all single use administered drugs and diagnostic or therapeutic radiopharmaceuticals?Billing-Discarded-Wasted Drugs-Adenosine-or-Radiopharmaceuticals-JW-JZ-Modifiers
11/19/2023Fluorodopa F-18 InjectionCould you please tell us how to code the FDA-approved (October 10, 2019) radiopharmaceutical F-18 labeled Fluorodopa, injection, a positron emission tomography (PET) imaging agent of the brain to visualize dopaminergic nerve terminals in the striatum for the evaluation of adult patients with suspected Parkinsonian syndromes (PS)?Fluorodopa-F-18-Injection
11/19/2023Locametz® (gallium Ga-68 gozetotide, Injection)Could you please tell us how to code the new FDA-approved (March 23, 2022) diagnostic radiopharmaceutical Gallium 68 gozetotide, injection, indicated for positron emission tomography (PET) of PSMA-positive lesions in adult patients with prostate cancer with suspected metastasis who are candidates for initial definitive therapy; with suspected recurrence based on elevated serum prostate-specific antigen (PSA) level; and for selection of patients with metastatic prostate cancer, for whom lutetium Lu 177 vipivotide tetraxetan PSMA-directed therapy is indicated.Locametz
11/19/2023Pluvicto™ (lutetium Lu-177 vipivotide tetraxetan)Could you please tell us how to code the new FDA approved (March 23, 2022) therapeutic injection procedure and radiopharmaceutical Pluvicto? This is for the treatment of adult patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) who have been treated with androgen receptor (AR) pathway inhibition and taxane-basedPluvicto
11/19/2023Lutathera® (lutetium Lu-177 dotatate)Could you please tell us how to code the new FDA approved (January 26, 2018) therapeutic injection procedure and radiopharmaceutical Lutathera®? This is for the treatment of somatostatin receptor positive gastroenteropanceatic neuroendocrine tumors (GEP-NETs), including foregut, midgut, and hindgut neuroendocrine tumors in adults.Lutathera
11/19/2023Billing Discarded (Wasted Radiopharmaceuticals) JW ModifierCan I bill for wasted radiopharmaceuticals using the JW modifier?Billing-Discarded-Wasted-Radiopharmaceuticals-JW-Modifier
8/18/2022Imaging for SarcoidosisWe are imaging for sarcoidosis and want to know which CPT codes to report?Imaging-for-Sarcoidosis
6/29/2022No Show ChargesI'm a Nuclear Medicine physician who is a part of a Pathology practice. We have new management who is interested in charging patients for their radiopharmaceutical when they are no shows. I always thought that this was not legal, but counsel for the organization says it is OK. Can you give me any information on this topic?No-Show-Charges
6/29/2022PI and PS ModifiersIs it only Medicare that requires the modifiers PI, PS, and KX when ordering PET/CT scans? Is KX still used and if so, what are the parameters for its use?PI-and-PS-Modifiers
6/13/2022Performing Multiple Level Bone SPECT'sI saw a recent Q&A asking if one could bill multiple instances of 78803, i.e. when an Abd and Pelvis SPECT was performed. The answer was no. Does this also apply to 78320 when having to perform 2 or even 3 levels of SPECT on a spine? Do we only bill/code one instance of 78320?Performing-Multiple-Level-Bone-SPECTs

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Do you have a question about coding and reimbursement that may be of interest to the nuclear medicine community? If so, enter your question here. Members of the SNMMI Coding and Reimbursement Committee will review your inquiry and post a reply to your question in this section.

The opinions referenced are those of the members of the SNMMI Coding and Reimbursement Committee and their consultants based on their coding experience. They are based on the commonly used codes in Nuclear Medicine, which are not all inclusive. Always check with your local insurance carriers as policies vary by region. The final decision for the coding of a procedure must be made by the physician considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. The SNMMI and its representatives disclaim any liability arising from the use of these opinions.