Will Medicare reimburse our non-hospital imaging center for LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension?
Effective 1/1/2016, Medicare released a product specific code Q9950 – Injection, sulfur hexafluoride lipid microspheres, per mL; and included this code and a national payment allowance in the Average Sales Price (ASP) drug pricing files. Assuming that coverage requirements are met, Q9950 should be paid separately for services provided in non-hospital imaging centers and physician offices. The current fee is $33.06 per mL. Lumason is a 5 mL vial. Prior to 1/1/2016, non-specific HCPCS code A9700 – Supply of injectable contrast material for use in echocardiography, per study – was assigned for LUMASON and payment (or not) was determined by the individual Medicare contractor.
An excerpt from the most recent information found on the CMS website (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/2016ASPFiles.html) states the following, “Where applicable, the payment amounts in the quarterly ASP files are 106 percent of the Average Sales Price (ASP) calculated from data submitted by drug manufacturers. The quarter to quarter price changes are generally the result of updated data from the manufacturers of these drugs.”