Calendar Year 2003 Nuclear Medicine Procedure and Radiopharmaceuticals - January 1, 2003

Transcription

1 Nuclear Medicine Procedure and Radiopharmaceuticals Thyroid, single uptake $ Thyroid, multiple uptakes $ Thyroid suppress/stimul $ Thyroid imaging with uptake $ Thyroid image, mult uptakes $ Thyroid imaging $ Thyroid imaging with flow $ Thyroid met imaging $ Thyroid met imaging/studies $ Thyroid met imaging, body $ Thyroid met uptake $ Parathyroid nuclear imaging $ Adrenal nuclear imaging $ Endocrine nuclear procedure $ Bone marrow imaging, ltd $ Bone marrow imaging, mult $ Bone marrow imaging, body $ Plasma volume, single $ Plasma volume, multiple $ Red cell mass, single $ Red cell mass, multiple $ Blood volume $ Red cell survival study $ Red cell survival kinetics $ Red cell sequestration $ Plasma iron turnover $ Iron absorption exam $ Red cell iron utilization $ Total body iron estimation $ Spleen imaging $ Platelet survival, kinetics $ Platelet survival $ Lymph system imaging $ Blood/lymph nuclear exam $ Liver imaging $ Liver imaging with flow $ Liver imaging (3D) $ Liver image (3d) w/flow $ Liver and spleen imaging $207.69

2 Nuclear Medicine Procedure and Radiopharmaceuticals Liver & spleen image/flow $ Liver function study $ Hepatobiliary imaging $ Salivary gland imaging $ Serial salivary imaging $ Salivary gland function exam $ Esophageal motility study $ Gastric mucosa imaging $ Gastroesophageal reflux exam $ Gastric emptying study $ Breath tst attain/anal C Breath test analysis, C Vit B-12 absorption exam $ Vit B-12 absorp exam, IF $ Vit B-12 absorp, combined $ Acute GI blood loss imaging $ GI protein loss exam $ Meckel s divert exam $ Leveen/shunt patency exam $ GI nuclear procedure $ Bone imaging, limited area $ Bone imaging, multiple areas $ Bone imaging, whole body $ Bone imaging, 3 phase $ Bone imaging (3D) $ Bone mineral, single photon $ Bone mineral, dual photon Musculoskeletal nuclear exam $ Non-imaging heart function $ Cardiac shunt imaging $ Vascular flow imaging $ Venous thrombosis study $ Acute venous thrombus image $ Venous thrombosis imaging $ Ven thrombosis images, bilat $ Heart muscle imaging (PET) Heart muscle blood, single $ Heart muscle blood, multiple $ Heart image (3d), single $340.59

3 Nuclear Medicine Procedure and Radiopharmaceuticals Heart image (3d), multiple $ Heart infarct image $ Heart infarct image $ Heart infarct image (3D) $ Gated heart, planar, single $ Gated heart, multiple $ Heart wall motion add-on $ Heart function add-on $ Heart first pass, single $ Heart first pass, multiple $ Heart image (PET), single Heart image (PET), multiple Heart image, SPECT $ Heart first pass add-on $ Cardiovascular nuclear exam $ Lung perfusion imaging $ Lung V/Q image single breath $ Lung V/Q imaging $ Aerosol lung image, single $ Aerosol lung image, multiple $ Perfusion lung image $ Vent image, 1 breath, 1 proj $ Vent image, 1 proj, gas $ Vent image, mult proj, gas $ Lung differential function $ Respiratory nuclear exam $ Brain imaging, ltd static $ Brain imaging, ltd w/ flow $ Brain imaging, complete $ Brain imaging, compl w/flow $ Brain imaging (3D) $ Brain imaging (PET) Brain imaging (PET) Brain flow imaging only $ Cerebral blood flow imaging $ Cerebrospinal fluid scan $ CSF ventriculography $ CSF shunt evaluation $ Cerebrospinal fluid scan $223.86

4 Nuclear Medicine Procedure and Radiopharmaceuticals CSF leakage imaging $ Nuclear exam of tear flow $ Nervous system nuclear exam $ Kidney imaging, static $ Kidney imaging with flow $ Imaging renogram $ Kidney flow/function image $ Kidney flow/function image $ Kidney flow/function image $ Kidney imaging (3D) $ Renal vascular flow exam $ Kidney function study $ Urinary bladder retention $ Ureteral reflux study $ Testicular imaging $ Testicular imaging/flow $ Genitourinary nuclear exam $ Tumor imaging, limited area $ Tumor imaging, mult areas $ Tumor imaging, whole body $ Tumor imaging (3D) $ Abscess imaging, ltd area $ Abscess imaging, whole body $ Abscess imaging (3D) $ Tumor imaging (PET) Nuclear medicine data proc Nuclear med data proc Provide diag radionuclide(s) Nuclear diagnostic exam $ Init hyperthyroid therapy $ Repeat hyperthyroid therapy $ Thyroid ablation $ Thyroid ablation, carcinoma $ Thyroid metastatic therapy $ Hematopoetic nuclear therapy $ Intracavitary nuclear trmt $ Interstitial nuclear therapy $ Nonhemato nuclear therapy $ Intravascular nuclear ther $212.74

5 Nuclear Medicine Procedure and Radiopharmaceuticals Nuclear joint therapy $ Provide ther radiopharm(s) Nuclear medicine therapy $ G0030 PET imaging prev PET single G $ G0031 PET imaging prev PET multple G $ G0032 PET follow SPECT singl G $ G0033 PET follow SPECT mult G $ G0034 PET follow SPECT singl G $ G0035 PET follow SPECT mult G $ G0036 PET follow cornry angio sing G $ G0037 PET follow cornry angio mult G $ G0038 PET follow myocard perf sing G $ G0039 PET follow myocard perf mult G $ G0040 PET follow stress echo singl G $ G0041 PET follow stress echo mult G $ G0042 PET follow ventriculogm sing G $ G0043 PET follow ventriculogm mult G $ G0044 PET following rest ECG singl G $ G0045 PET following rest ECG mult G $ G0046 PET follow stress ECG singl G $ G0047 PET follow stress ECG mult G $ G0125 Lung image (PET) G $1, G0126 Lung image (PET) staging G0163 PET for rec of colorectal ca G0164 PET for lymphoma staging G0165 PET,rec of melanoma/met ca G0210 PET Imaging whole body; dx lung CA G $1, G0211 PET Imaging whole body; initial lung (Replaces G0126) G $1, G0212 PET Imaging whole body, restaging lung G $1, G0213 PET Imaging whole body; dx colorectal Ca G $1, G0214 PET Imaging whole body; initial staging, colorectal Ca G $1,375.00

6 Nuclear Medicine Procedure and Radiopharmaceuticals - G0215 PET Imaging whole body; restaging, colorectal CA (Replaces G0163) G $1, G0216 PET Imaging whole body, dx melanoma G $1, G0217 PET Imaging whole body, initial staging G $1, G0218 PET Imaging whole body; restaging, melanoma (Replaces G0165) G $1, G0219 PET Imagingwhole body; melanoma for non-covered indications G $1, G0220 PET Imaging whole body; dx lymphoma G $1, G0221 PET Imaging whole body; initial staging lymphoma (Replaces G0164) G $1, G0222 PET Imaging whole body; restaging, lymphoma (Replaces G0164) G $1, G0223 PET Imaging whole body or regional; dx head & neck Ca G $1, G0224 PET Imaging whole body or regional; initial staging, head & neck Ca G $1, G0225 PET Imaging whole body or regional; restaging, head & neck Ca G $1, G0226 PET Imaging whole body; dx esophageal Ca G $1, G0227 PET Imaging whole body; initial staging esophageal Ca G $1, G0228 PET Imaging whole body; restaging, esophageal Ca G $1, G0229 PET Imaging; Metabolic brain imaging, pre-surg eval of refract seizures G $1, G0230 PET Imaging; Metabolic assess myocard viability foll incon SPECT G $1, G0231 PET Whole Body, Colorectal; Gamma Camera G $1, G0232 PET Whole Body, Lymphoma; Gamma Camera G $1, G0233 PET Whole Body, Melanoma; Gamma Camera G $1, G0234 PET Whole Body, Pulmonary Nodule; Gamma Camera G $1, GOAAA Pet Imaging for initial diagnosis of breast cancer and/or surgical G planning for breast cancer (example initial staging of axillary lymph Not covered by Medicare nodes) GOBBB PET Imaging for breast cancer, full & partial-ring PET scanners only, G $1, staging/restaging after or prior to course of treatment GOCCC PET Imaging for breast cancer, full & partial-ring PET scanners only, G $1, evaluation of response to treatment, performed during course of treat G0273 Radiopharmaceutical biodistribution, single or multiple scans on one or more G $2, days, pre-treatment planning for radiopharmaceutical therapy of non-hodgkin s lymphoma, includes administration of radiopharmaceutical See section XVII (e.g., radiolabeled antibodies) CMS Memorandum Pretx planning, non-hodgkin's A G0274 Radiopharmaceutical Therapy, non-hodgkin s lymphoma, includes G $20, administration of radiopharmaceutical (e.g., radiolabeled antibodies) Radiopharm tx, non-hodgkin's

7 Nuclear Medicine Procedure and Radiopharmaceuticals - RADIOPHARMACEUTICAL DESCRIPTIONS A4641 Diagnostic imaging agent A4641 N Packaged into APC rate A4642 Satumomab pendetide per dose A4642 N Packaged into APC rate A9500 Technetium TC 99m sestamibi A9500 N Packaged into APC rate A9502 Technetium TC99M tetrofosmin, per dose A9502 N Packaged into APC rate A9503 Technetium TC 99m medronate A9503 N Packaged into APC rate A9504 Technetium tc 99m apcitide A9504 N Packaged into APC rate A9505 Thallous chloride TL 201/1mci A9505 N Packaged into APC rate A9507 Indium/111 capromab pendetid, per dose A K $ A9508 Iobenguane Sulfate I-131, per 0.5 mci A K $81.86 A9510 Technetium Tc-99m Disofenin A9510 N Packaged into APC rate A9511 Technetium 99m Depreotide per mci A K $ A9512 Technetium Tc99m Pertechnatate A9512 N Packaged into APC rate A9513 Technetium Tc99m Mebrofenin A9513 N Packaged into APC rate A9514 Technetium Tc99m Pyrophosphate A9514 N Packaged into APC rate A9515 Technetium Tc99m Pentetate A9515 N Packaged into APC rate A9516 I-123 Sodium Iodide Capsule A9516 N Packaged into APC rate A9517 I-131 Sodium Iodide Capsule A9517 N Packaged into APC rate A9518 I-131 Sodium Iodide Solution A K $49.02 A9519 Technetium Tc99m Macroag Albu A9519 N Packaged into APC rate A9520 Technetium Tc99m Sulfur Colloid A9520 N Packaged into APC rate A9521 Technetium 99m Exametazine A K $ A9522 Indium-111 Ibritumonomabtiuxetan A9522 E Packaged - G0273 A9523 Yttrium-90 Ibritumonomabtiuxetan A9523 E Packaged - G0274 A9524 Iodinated I-131 Serum Albumin A9524 N Packaged into APC rate A9600 Strontium-89 Chloride, per mci A K $ A9603 I-131 Sodium Iodide Capsule, per mci A9603 N Packaged into APC rate A9605 Samarium-153 lexidronamm, 50 mci A K $ A9699 Noc therapeutic Radiopharmaceutical A9699 N Packaged into APC rate C1045 I-131 MIBG (ioben-sulfate) 0.5 mci Replaced by A9508 C1058 Technetium 99m Oxidronate, per vial Replaced by Q3009 C1064 I-131 Cap, each additional mci Replaced by A9517 C1065 I-131 Sol, each additional mci Replaced by A9518 C1066 In111 Satumomab Pendetide Replaced by A4642 C1079 Co58/Co57 Kit, 0.5 mci Deleted C1087 C1089 C1090 Iodine I-123 (capsule), per uci CO57 57/58, 0.5 mci IN-111 Chloride, per mci Replaced by A9516 Deleted Deleted

8 Nuclear Medicine Procedure and Radiopharmaceuticals - C1091 IN-111 Oxyquinoline, per 0.5 mci C K $ C1092 IN-111 Pentetate, per 0.5 mci C K $ C1094 Tc99m Album Aggregate, 1.0 mci C1094 N Packaged into APC rate C1095 Tc99m Depreotide, per vial Replaced by A9511 C1096 Tc99m Exametazime, per dose C K $ C1097 Tc99m Mebrofenin, per vial C1097 N Packaged into APC rate C1098 Tc99m Pentetate, per vial C1098 N Packaged into APC rate C1099 Tc99m Pyrophosphate, per vial C1099 N Packaged into APC rate C1122 Tc99m Arcitumomab, per vial C K $ C1188 Iodine I-131 CAP, per 1-5 mci Replaced by A9517 C1200 Tc99m Glucoheptonate C1200 N Packaged into APC rate C1201 Tc99m Succimer, per vial C1201 N Packaged into APC rate C1202 Tc99m Sulfur Colloid, per dose Replaced by A9520 C1205 Tc99m Disophenin, per vial Replaced by A9510 C1207 Octreotide acetate depot 1 mg J K $46.81 C1348 I-131 Solution, per 1-6 mci Replaced by A9518 C1775 FDG, per dose (4-40 mci) C K $ C9000 Injection, Cr51, per 0.25 mci C K $98.03 C9013 Co57 cobaltous chloride C9013 N Packaged into APC rate C9100 Iodine I-131 Albumin, per mci Replaced by A9524 C Sodium chromate, per 50 mci C9102 N Packaged into APC rate C9103 Sodium Iothalamate I-125, per 10 uci C9103 N Packaged into APC rate J0150 Injection adenosine 6 MG J0150 N Packaged into APC rate J0151 Adenosine injection J K $ J1245 Dipyridamole injection J1245 N Packaged into APC rate J1250 Inj dobutamine HCL/250 mg J1250 N Packaged into APC rate Q3000 Rubidium Rb-82 Q K $ Q3002 Gallium Ga-67, per mci Q3002 N Packaged into APC rate Q3003 Tc99m Biscate, per unit dose Q K $ Q3004 Xenon XE 133, per 10 mci Q3004 N Packaged into APC rate Q3005 Tc99m Mertiatide, per mci Q3005 N Packaged into APC rate Q3006 Tc99m Gluceptate Q3006 N Packaged into APC rate Q3007 Sodium Phosphate P-32 Q3007 N Packaged into APC rate Q3008 In 111 Pentetreotide Q K $ Q3009 Tc99m oxidronate Q3009 N Packaged into APC rate Q3010 Tc99m Labeled red cell Q3010 N Packaged into APC rate Q3011 Chromic Phosphate P-32, per mci Q K $82.87 Q3012 Co57, 0.5 mci Capsule Q3012 N Packaged into APC rate

9 Nuclear Medicine Procedure and Radiopharmaceuticals -