Question:
How do we bill for an echocardiogram when we use your product Lumason? We are not a hospital and everything I can find says Q9950 can only be billed with the C codes for the hospital.
Answer:
It is not true that Lumason (Q9950) can only be billed with the C codes for hospitals. In fact, while hospitals should report Q9950 when they do an echocardiogram with contrast, they do not get paid separately for the contrast material, at least by Medicare. Non-hospital offices and facilities do get paid when billing under the Medicare Physician Fee Schedule. And in fact, Medicare allows you to bill for the discarded amounts with modifier JW. So that if you give 2 mL out of the 5 mL vial, you would bill Q9950 x two units on one line and Q9950-JW x three units on a second line and you would get paid for all five units.
CPT® copyright 2024 American Medical Association (AMA). All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
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