In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
Barrs T. Establishing safeguards for the use of imaging-related drugs. Am J Health Syst Pharm. 2002;59(15):1449-1453. Also available on the Pub Med Web site at: http://www.medscape.com/viewarticle/442004_print. Accessed October 21, 2015.
Brant, William E. Fundamentals of Diagnostic Radiology. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 2007.
Centers for Medicare & Medicaid Services (CMS). 2 CFR parts 410, 411, 412, et al. Medicare and Medicaid programs; interim and final rule. Part III: (196). 4 [CMS Web site]. 11/27/07. Available at: http://www.cms.hhs.gov/quarterlyproviderupdates/downloads/cms1392fc.pdf. Accessed October 21, 2015.
Centers for Medicare & Medicaid Services (CMS). CMS Manual System.Transmittal 502. Pub. 100-04: Medicare claims processing: New contrast agents Healthcare Common Procedure Coding System (HCPCS) codes. [CMS Web site]. 01/13/2012. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2386CP.pdf Accessed October 21, 2015
Centers for Medicare & Medicaid Services (CMS). CMS Manual System. Transmittal 804. Pub 100-04: Medicare claims processing.Revision 3280- 06-15-2015 update of the hospital outpatient prospective payment system (OPPS): Summary of payment policy changes, OPPS PRICER logic changes, and instructions for updating the outpatient provider specific file (OPSF). [CMS Web site]. 06-15-2015 Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c04.pdf . Accessed October 21, 2015
Centers for Medicare & Medicaid Services (CMS). Medicare Claims Processing Manual.Ch 13: Radiology services and other diagnostic procedures. [CMS Web site]. revised 04-13-2015 Available at:https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c13.pdf Accessed October 21, 2015.
New Contrast Agents Healthcare Common Procedure Coding System (HCPCS) Codes." MLN Matters. April 1, 2005. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM3748.pdf Accessed November 11, 2015.
Q9965 Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml
Q9966 Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml
Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
Policy: 09.00.13c:High Osmolar Contrast Agents
Policy: 09.00.45g:Magnetic Resonance Imaging (MRI) Contrast Agents