Radiology Question for the Week of March 14, 2016

Question:

What is the code for Isovue®-370 (iopamidol injection 76%)? I have Q9967 but it shows up in the Medicare physician fee schedule (MPFS) as excluded with no payment.   

Answer

Q9967 (low osmolar contrast material, 300–399 mg/ml iodine concentration, per mL) is correct for Isovue®-370.  

Drugs with HCPCS level codes are not included in the MPFS. To find the payment amounts, you must look them up in the  Medicare average sales price (ASP) drug file. There are some that are coded as unlisted, and their fees are listed in the NOC (not otherwise classified) pricing file. When you don’t know what the HCPCS code for a particular drug is, you can check the ASP NDC-HCPCS crosswalk, which lists drug names, manufacturers, and national drug code (NDC) numbers as well as the appropriate HCPCS code. 

Links to all of the above files can be found at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/2016ASPFiles.html. Scroll down to the bottom of the page under “Related Links” where you will see the most current quarterly version. The Centers for Medicare & Medicaid Services (CMS) add new files as they become available.

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