General Question for the Week of October 12, 2020

Question:

When we perform a nuclear medicine thyroid scan and uptake using I 123 capsules are we allowed to charge the patient for the standard capsules?

Answer:

You should report them on your claims, but the cost is included in the payment you receive from the payer – at least for Medicare. You cannot separately bill Medicare patients as diagnostic radiopharmaceuticals are considered packaged into the nuclear medicine scan. For insurances other than Medicare, it is necessary to check the payer’s policies – or your EOBs should tell you whether or not the radiopharmaceutical can be balanced billed to the patient.