Radiology Question for the Week of February 19, 2024

Question:

How do we code and bill for adenosine when we do not use the entire vial on a Medicare patient? Also, does this policy apply to radiopharmaceuticals or for all single-use administered drugs and diagnostic or therapeutic radiopharmaceuticals?

Answer:

Medicare only covers discarded drugs for single use vials; multi-use vials are not subject to payment for discarded amounts of drugs. Since adenosine is supplied as a single use vial, there are several scenarios regarding how to code and bill based on the vial used, (60 mg or 90 mg) and the patient administered dose, which is based on the patients’ weight.

Medicare encourages physicians to schedule patients in such a way that they can use drugs or radiopharmaceuticals most efficiently. However, if a physician must discard the remainder of a single-use vial, the Medicare program covers the amount of drug or radiopharmaceutical discarded/decayed/wasted along with the amount administered.

Effective July 1, 2023, providers of separately paid drugs or radiopharmaceuticals from single-use administrations are now required to report the waste with the JW modifier or if there is no waste to report the JZ modifier. This is important for CMS tracking and for consistency across the Medicare Administrative Contractors (MACs).

Note: There have been many changes to coding for adenosine from 2013 to 2015 for dates of service prior to January 1, 2014 providers use HCPCS level II code J0152, Injection, Adenosine, for diagnostic use, per 30 mg increments, for dates of service January 1, 2014 to December 31, 2014 providers would report the new in 2014 HCPCS level II code J0151 Injection, Adenosine, for diagnostic use, per milligram and for dates of service on or after January 1, 2015 and beyond use HPCPS level II code J0153 Injection, Adenosine, diagnostic, per milligram.