Cardiology Question for the Week of November 19, 2018

Cardiology Compliance Question of the Week

Question:

Could you inform me as to the status of Medicare reimbursement for the ultrasound contrast agent Lumason. Although we use this for echocardiography, we would like to know if we can receive payment just for it alone.

Answer:

Lumason (Q9950) had pass-through status through December 31, 2017 and was separately paid. However, effective January 1, 2018, it lost pass-through status and became packaged and not separately paid for hospital billing under the outpatient prospective payment system (OPPS).

However, due to an addition to the Omnibus Appropriations Bill that Congress passed in March, 2018, several drugs, including Lumason, got their pass-through status back beginning in October, 2018.

Non-hospital offices and imaging centers should be paid separately for Lumason.

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.