Question:

I am in the process of setting fees up in our imaging center billing system for radiopharmaceuticals used in nuclear medicine procedures. The Medicare Physician Fee Schedule (MPFS) does not give payment amounts for radiopharmaceuticals. Do you know if and how they are paid?

Answer:

Medicare does pay for radiopharmaceuticals for non-hospital imaging centers, but the Centers for Medicare & Medicaid Services (CMS) lets each Medicare Administrative Contractor (MAC) determine payment amounts for radiopharmaceuticals. Most pay based on either invoice price or acquisition costs. Check your MAC’s website for a contractor-priced fee schedule, or an article discussing radiopharmaceutical reimbursement.

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