Pharmacy Question for the Week of July 12, 2021

Pharmacy Compliance Question of the Week

Question:

How does CMS account for radiopharmaceutical payment if it falls under indicator “N”?

Answer:

For diagnostic radiopharmaceuticals with status indicator “N,” CMS bundles the cost into the procedure payment rate. CMS and medical specialty societies strongly encourage facilities to code and bill separately for radiopharmaceuticals regardless of their status indicator. CMS also states, “All these charges play a role in defining future hospital payment.”