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.
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Iodine is the only element that has 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. Reductions in osmolality, in comparison to high osmolar contrast agents, are achieved by making compounds that are nonionic monomers (i.e., iopamidol, iohexol, iversol), nonionic dimers (i.e., iodixanol, ioxilan), or monoacidic dimers (i.e., ioxaglate). Iodixanol is iso-osmolar. Low osmolar contrast agents have been used in radiological diagnosis studies when the use of other contrast material could be detrimental to an individual's health (e.g., a history of adverse reactions to contrast material; a history of asthma or allergy; significant cardiac dysfunction; generalized severe debilitation; or sickle cell disease). Low osmolar contrast agents, which include iso-osmolar agents, have a lower risk of adverse reaction than high osmolar contrast agents.
Barrs T. Establishing safeguards for the use of imaging-related drugs. American Journal of Health-System Pharmacy. 2002;59(15):1449-1453. Available at: http://www.medscape.com/viewarticle/442004. Accessed August 15, 2019.
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). 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 August 15, 2019.
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 15, 2019.
Centers for Medicare & Medicaid Services (CMS). MLN Matter. 3748: New Contrast Agents Healthcare Common Procedure Coding System (HCPCS) Codes. [CMS Web site]. 04/01/2005. Available at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM3748.pdf. Accessed August 15, 2019.
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: 09.00.45h:Magnetic Resonance Imaging (MRI) Contrast Agents