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.
Iodine is the only element that is proven satisfactory for general use as an intravascular contrast medium for radiography. All iodinated contrast agents have a chemical structure that is based on a benzene ring containing three iodine atoms. High osmolar contrast media are acid salts that dissociate in water into an inodine-containing, negatively charged anion (i.e., diatrizoate, iothalamate), and a positively charged cation. The high osmolality and viscosity of these agents can cause significant hemodynamic, cardiac and subjective effects including vasodilatation, heat, pain, osmotic diauresis, and decreased myocardial contractility.
Brant M.D., William E, Helms M.D., Clyde A., Klein M.D. FACR, Jeffrey, Vinson M.D., Emily N. Fundamentals of Diagnostic Radiology, Fifth edition. Philadelphia: LWW; Lippincott, Williams & Wilkins, 2018.
Centers for Medicare & Medicaid Services (CMS). Medicare Claims Processing Manual. Chapter 13: Radiology Services and Other Diagnostic Procedures. [CMS Web site]. Revised 03-27-2019. Available at:https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c13.pdf. Accessed August 12, 2019.
Centers for Medicare & Medicaid Services (CMS). MLN Matters. 3847: New Healthcare Common Procedure Coding System (HCPCS) drug codes. [CMS Web site]. 03/28/2013. Available at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3847.pdf. Accessed August 12, 2019.
Q9959 High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml
Q9960 High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml
Q9961 High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml
Q9962 High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml
Q9963 High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml
Q9964 High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml
Policy: 09.00.31d:Low Osmolar Contrast Agents
Policy: 09.00.45h:Magnetic Resonance Imaging (MRI) Contrast Agents