Ultrasound Question for the Week of March 7, 2016

Question:

Will Medicare reimburse hospitals for LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension?

Answer

Effective 10/1/2015, LUMASON has “pass-through” status for out-patient hospital billing under the Hospital Outpatient Prospective Payment System (HOPPS) and will therefore be separately paid (assuming coverage conditions are met).  The national payment rate is currently $33.06 per mL.  LUMASON is supplied in a 5 mL vial.

See the following CMS-link https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices-Items/CMS-1633-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending  for additional, detailed information relative to HOPPS, specifically, “2016 HOPPS Final Rule Addenda”

See the following CMS link for Medicare coverage policies and articles at: https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx.

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