Question:

Could you inform me as to the status of Medicare reimbursement for the ultrasound contrast agent Lumason. Although we use this for echocardiography, we would like to know if we can receive payment just for it alone.

Answer:

Lumason (Q9950) had pass-through status through December 31, 2017 and was separately paid. However, effective January 1, 2018, it lost pass-through status and became packaged and not separately paid for hospital billing under the outpatient prospective payment system (OPPS).

However, due to an addition to the Omnibus Appropriations Bill that Congress passed in March, 2018, several drugs, including Lumason, got their pass-through status back beginning in October, 2018.

Non-hospital offices and imaging centers should be paid separately for Lumason.

Facebook
Twitter
LinkedIn
Email
Print

CPT® copyright 2021 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.