Pharmacy Question for the Week of October 8, 2018

Question:

What is the Medicare policy for physician office radiopharmaceutical payments?

Answer:

In the physician office setting, radiopharmaceuticals (RPs) are not subject to average sales price (ASP) methodology for payment. Increasingly, Medicare contractors are switching to payments for RPs at invoice cost, so you may want to ask your RP provider to incorporate the cost of transportation with the line item cost of the RP to facilitate communicating the full RP cost to the payer. Invoices may be required.

Note that Medicare contractors have discretion in establishing rates, as all RPs are currently carrier-priced in this setting. Check with your Medicare contractor for local allowable rates. As always, code and bill for RPs and drugs regardless of payment status by the payers as this is proper coding per the introductory section of CPT^®.

CPT^® is a registered trademark of the American Medical Association.