NUCLEARMEDICINERADIOPHARMACEUTICALS

In 2012, Medicare added HCPCScode Q9969 (Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose) to provide additional reimbursement for Tc-99 derived from a non-HEU source, which is more costly

The objective of the additional reimbursement is to eliminate domestic reliance on Tc-99m derived from nuclear reactors using Highly Enriched Uranium (HEU). CMSwill reimburse providers $10 per non-HEU derived Tc-99m dose in the hospital outpatient setting in addition to the payment for the imaging procedure

Hospitals report Q9969 once per dose, in addition to the Tc-99m code (such as A9541, for example.) The HCPCSQ9969 is reimbursed one time per study dose. For example, if separate doses of Tc-99m are provided for a study at rest study and a stress study, the hospital would report Q9969 x 2, in addition to the line item reporting the isotope itself

As long as the Tc-99m doses used can be certified by the hospital to be at least 95 percent derived from non-HEU sources, Q9969 may be reported in addition to the A95XXcode Hospitals should maintain documentation that the dose was derived from a non-HEU source by means of product invoices, patient dose labels, or tracking sheets that indicate that a dose was produced from non-HEU sources. Isotope purchasing managers should inquire if the Tc-99 manufacturer has labeled a generator or a dose attesting to it being derived from a non-HEU source

Questions about whether the Tc-99Mm was derived from a non-HEU source should be directed to the manufacturer or radiopharmaceutical supplier

Download the complete guide, along with more tables from the Para Data Editor (PDE) by clicking here