Cardiology Coding Alert
Add Acquisition Cost to Radiopharmaceutical Claim
Question: We’ve seen denials for our A9505 claims. We checked the units, and we’re reporting it on the same claim as the test code. Any thoughts on what might be causing the denial?
Maryland Subscriber
Answer: One possibility is that you need to include the acquisition cost on the claim. Maryland’s Part B MAC requires providers to report the total acquisition cost (matching the invoice you keep on file) in Block 19 or 24D of the CMS-1500 claim form or in in the 2400 loop NTE segment of an electronic claim. This rule applies to all radiopharmaceuticals, including A9505 (Thallium tl-201 thallous chloride, diagnostic, per millicurie).
To view the payer’s article, open www.novitas-solutions.com/webcenter/spaces/Bulletins_JH. In the top right search box, enter “New Reimbursement Guidelines for Radiopharmaceutical Procedure Codes.” Then choose the article of the same name from the list of results.
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Add Acquisition Cost to Radiopharmaceutical Claim
Question: We’ve seen denials for our A9505 claims. We checked the units, and we’re reporting [...]
