Charging patients for a nuclear medicine thyroid scan and uptake using i-123 capsules

Q.

When we perform a nuclear medicine thyroid scan and uptake using i-123 capsules are we allowed to charge the patient for the standard capsules used to assist in calculating the thyroid uptake??

A.

 You should report them on your claims, but the cost is included in the payment you receive from the payer – at least for Medicare. You cannot separately bill Medicare patients as diagnostic radiopharmaceuticals are considered packaged into the nuclear medicine scan. For more information see the Medicare Claims Processing Manual, Chapter 17, Section 90.2 sub-section A states: “Hospitals should report charges for all drugs, biologicals, and radiopharmaceuticals, regardless of whether the items are paid separately or packaged, using the correct HCPCS codes

for the items used. It is also of great importance that hospitals billing for these products make certain that the reported units of service of the reported HCPCS code are consistent with the quantity of a drug, biological, or radiopharmaceutical that was used in the care of the patient.”

For insurances other than Medicare, it is necessary to check the payer’s policies – or your EOBs should tell you whether or not the radiopharmaceutical can be balanced billed to the patient.