Radiology Question for the Week of February 27, 2017

Question:

Question:

Can you tell me the codes for the MRI contrast materials ProHance® (Gadoteridol) Injection, 279.3 mg/mL and MultiHance® (gadobenate dimeglumine) injection, 529 mg/mL?

Answer:

Answer:

There are two codes to choose from for each of these products. MultiHance single-use products are reported with code A9577, while MultiHance® Multipack™ (gadobenate dimeglumine) injection 529 mg/mL is reported with code A9578.

A9577 Injection, gadobenate dimeglumine (MultiHance), per mL
A9578 Injection, gadobenate dimeglumine (MultiHance Multipack), per mLIf intravenous contrast is used, also report the appropriate HCPCS code for the contrast material.

ProHance® Multipacktm (Gadoteridol) injection, 279.3 mg/mL is reported with code A9576 while Prohance single-use products are reported with the generic gadolinium code A9579.

A9576 Injection, gadoteridol, (ProHance Multipack), per mL
A9579 Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (NOS), per mL

All four of these codes are reported per mL given. They are packaged under the hospital outpatient prospective system (HOPPS) for outpatient hospital billing but should be paid separately for non-hospital imaging centers and physician offices.

MultiHance® (gadobenate dimeglumine) injection, 529 mg/mL
and ProHance® (Gadoteridol) Injection, 279.3 mg/mL

Indications and Usage for MultiHance:
MultiHance is a gadolinium-based contrast agent indicated for intravenous use in:

  • Magnetic resonance imaging (MRI) of the central nervous system (CNS) in adults and children over 2 years of age to visualize lesions with abnormal blood-brain barrier or abnormal vascularity of the brain, spine, and associated tissues and
  • Magnetic resonance angiography (MRA) to evaluate adults with known or suspected renal or aorto-ilio-femoral occlusive vascular disease

Indications and Usage for ProHance:
CENTRAL NERVOUS SYSTEM
ProHance is indicated for use in MRI in adults and children over 2 years of age to visualize lesions with abnormal vascularity in the brain (intracranial lesions), spine, and associated tissues.

EXTRACRANIAL/EXTRASPINAL TISSUES
ProHance is indicated for use in MRI in adults to visualize lesions in the head and neck.

IMPORTANT SAFETY INFORMATION for MultiHance and ProHance

WARNING: NEPHROGENIC SYSTEMIC FIBROSIS

Gadolinium-based contrast agents (GBCAs) increase the risk for NSF among patients with impaired elimination of the drugs. Avoid use of GBCAs in these patients unless the diagnostic information is essential and not available with non-contrasted MRI or other modalities. NSF may result in fatal or debilitating systemic fibrosis affecting the skin, muscle and internal organs.

• The risk for NSF appears highest among patients with:

• chronic, severe kidney disease (GFR <30 mL/min/1.73m2), or
• acute kidney injury.

• Screen patients for acute kidney injury and other conditions that may reduce renal function. For patients at risk for chronically reduced renal function (e.g. age > 60 years, hypertension or diabetes), estimate the glomerular filtration rate (GFR) through laboratory testing.

• For patients at highest risk for NSF, do not exceed the recommended MultiHance/ProHance dose and allow a sufficient period of time for elimination of the drug from the body prior to re-administration. (see WARNINGS)

MultiHance
Anaphylactic and anaphylactoid reactions have been reported, involving cardiovascular, respiratory, and/or cutaneous manifestations ranging from mild to severe. The possibility of a reaction should always be considered, especially in those patients with a history of a known clinical hypersensitivity or a history of asthma or other allergic disorders.

ProHance
As with all paramagnetic agents, caution should be exercised in patients with deoxygenated sickle erythrocytes and renal insufficiency with or without hepatic impairment. The possibility of a reaction, including serious, life threatening, or fatal, anaphylactic or cardiovascular reactions, or other idiosyncratic reactions, should always be considered, especially in those patients with a history of a known clinical hypersensitivity or a history of asthma or other allergic disorders.

Please see full Prescribing Information for MultiHance including boxed WARNING by clicking here.

Please see full Prescribing Information for ProHance including boxed WARNING by clicking here.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

MultiHance is manufactured for Bracco Diagnostics Inc. by BIPSO GmbH – 78224 Singen (Germany) and by Patheon Italia S.p.A, Ferentino, Italy.

ProHance is manufactured for Bracco Diagnostics Inc. by BIPSO GmbH – 78224 Singen (Germany).

MultiHance is a registered trademark of Bracco International B.V.

ProHance is a registered trademark of Bracco Diagnostics Inc.