Ultrasound Question for the Week of April 4, 2016

Question:

Do I bill LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension according to the amount given, or per vial? 

Answer

LUMASON is billed per mL given.  There are 5 mL’s per vial. Medicare allows you to also bill the discarded amount from single dose vials such as LUMASON.  Modifier –JW (Drug amount discarded/not administered to any patient) may be required for the discarded amount.  Even if –JW is not required, you may use it to track discarded drugs. 

The LUMASON syringe contains 5 mL after reconstitution.  If 2 mL are administered and 3 mL discarded, there are 2 billing options depending on whether –JW modifier is used. 

One 2 mL dose given: 

Option 1 – JW modifier:

Q9950, 2 units

Q9950-JW, 3 units

Option 2 – no modifier

Q9950, 5 units

Answer: