Cardiology Question for the Week of June 28, 2021

Cardiology Compliance Question of the Week


How do we bill for an echocardiogram when we use your product Lumason? We are not a hospital and everything I can find says Q9950 can only be billed with the C codes for the hospital.


It is not true that Lumason (Q9950) can only be billed with the C codes for hospitals. In fact, while hospitals should report Q9950 when they do an echocardiogram with contrast, they do not get paid separately for the contrast material, at least by Medicare. Non-hospital offices and facilities do get paid when billing under the Medicare Physician Fee Schedule. And in fact, Medicare allows you to bill for the discarded amounts with modifier JW. So that if you give 2 mL out of the 5 mL vial, you would bill Q9950 x two units on one line and Q9950-JW x three units on a second line and you would get paid for all five units.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.