Ultrasound Question for the Week of February 29, 2016

Question:

What HCPCS code would I use for LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension?  I’ve been told three different codes and I’m confused.

Answer

Your confusion is understandable.  Since the FDA approved LUMASON for use in the U.S., the appropriate billing code has changed from non-specific code, to a “C” code, to a “Q” code in 2015.  

As of January 1, 2016, the correct code regardless of facility type is Q9950 – Injection, sulfur hexafluoride lipid microspheres, per mL.   

For outpatient hospital claims from 10/1/2015 – 12/31/2015, LUMASON was coded C9457 – Injection, sulfur hexafluoride lipid microsphere, per mL.  

For outpatient hospital claims before 10/1/2015, and non-hospital imaging center and physician office claims before 1/1/2016, the non-specific code A9700 was coded.  A9700 -Supply of injectable contrast material for use in echocardiography, per study.

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