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MEDICAID INFORMATION RELEASE MA05-02   
 
TO:                  Hospitals and Nuclear Medicine Providers
 
FROM: Leslie Clement, Acting Deputy Administrator
 
SUBJECT:       BILLING CLARIFICATION AND INFORMATION CONCERNING HOW TO PROPERLY BILL IDAHO MEDICAID FOR RADIONUCLIDE/CONTRAST MEDIA
 
Hospitals and physicians usually use procedure code A4641 - Supply of radiopharmaceutical diagnostic imaging agent, not otherwise classified, to bill radionuclide/contrast material.  This code must be manually priced and an invoice is required.   Often, the billing information does not match the invoice which makes it difficult or impossible to correctly price the claim.
 
In order to expedite this process, Medicaid has added more procedure codes with specific descriptions.  When using these codes, providers must bill with the dosage as described below.  When using these codes or A4641, the invoice must clearly state what is being billed.  If it is necessary to write the dosage on the invoice, please do so.  Billing A4641 with a unit of one (1) does not correspond with the invoice that reads per 200 uci or 50 mg.
 
HCPCS Code              Description                                                               
A9500
Technetium Tc 99m sestambi, per dose
A9502
technetium Tc 99m medronate, up tp 30 millicurie
A9503
technetium Tc 99 tetrofosmin, per unit dose
A9504
technetium Tc 99m apcitide
A9505
thallous chloride TL-201, per millicurie
A9507
indium in 111 capromab pendetide, per dose
A9508
iobenguane sulfate I-131, per 0.5 millicurie
A9510
technetium Tc 99m disofenin, per vial
A9511
technetium Tc 99m depreotide, per millicurie
A9512
technetium Tc 99m pertechnetate, per mci
A9513
technetium Tc 99m mebrofenin, per mci
A9514
technetium Tc 99m pyrophosphate, per mci
A9515
technetium Tc 99m pentetate, per mci
A9516
I-123 sodium iodide capsule, per 100 uci
A9517
I-131 sodium iodide capsule, per mci
A9519
technetium Tc 99m macroaggregated albumin, per mci
A9520
technetium Tc 99m sulfur colloid, per mci
A9521
technetium Tc 99m exametazine, per dose
A9522
indium-111 ibritumomab tiuxetan, per mci
A9523
yttrium 90 ibritumomab tiuxetan, per mci
A9524
iodinated I-131 serum albumin, 5 microcuries
A9525
low or iso-osmolar contrast material, 10 mg of iodne
A9526
ammonia N-13, per dose
A9528
I-131 sodium iodide capsule, per millicurie
A9529
I-131 sodium iodide solution, per millicurie
A9530
I-131 sodium iodide solution, per millicurie
A9531
I-131 sodium iodide, per millicurie (up to 100 microcuries)
A9532
iodinated I-125, serum albumin, 5 microcuries
A9533
I-131 tositumomab, per millicurie
A9534
I-131 tositumomab, per millicurie
A9600
strontium-89 chlride, per millicurie
A9605
samarium am 153 lexidronamm, 50 millicurie
A9699
NOC
A9700
injectable contrast material for use in echocardiography, per study
 
 
 
We appreciate your continued participation in the Idaho Medicaid program.  If you have questions concerning billing for these services, please call EDS at 1-800-685-3757 or locally at 383-4310.
 
IDAHO MEDICAID PROVIDER HANDBOOK
This Information Release does not replace information in your Idaho Medicaid Provider Handbook.
 
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