January 9, 2012
CMS HCPCS Level II Codes Effective January 1, 2012
The 2012 Healthcare Common Procedure Coding System (HCPCS) electronic file has been posted with updated file information on the Centers for Medicare and Medicaid Services (CMS) web site. There were no HCPCS Level II code revisions important to nuclear medicine procedures for CY 2012. However, there were important changes made regarding two diagnostic imaging radiopharmaceutical codes. These new and deleted codes are effective January 1, 2012 and are listed in the table below.
Note: DaTscan™ is a radiopharmaceutical indicated for striatal dopamine transporter visualization using single photon computed tomography (SPECT) braining imaging to assist the evaluation of adult patients with suspected Parkinsonian syndromes (PS).
C9406 was originally granted hospital Outpatient Prospective Payment System (OPPS) Transitional Pass-Through Status by CMS effective July 1, 2011 and is now replaced by permanent HCPCS Level II Code A9584 effective January 1, 2012. A9584 maintains Transitional Pass-Through Status for CY 2012 and is assigned OPPS Status Indicator of “G” (Pass-Through Drugs and Biologicals. Paid under OPPS; separate APC payment). Use A9584 for all settings, i.e., hospital outpatient, physician office, independent diagnostic imaging facilities (IDTFs) and all third party payers for claims with dates of service on or after January 1, 2012.
For more details see the SNM Practice Management Coding Corner article on DaTscan™.
For additional HCPCS Level II Code additions, revisions and deletions, please download the 2012 Alpha-Numeric HCPCS File on the CMS web site.
The opinions referenced are those of the members of the SNM Coding and Reimbursement Committee and their consultants based on their coding experience. They are based on the commonly used codes in Nuclear Medicine, which are not all inclusive. Always check with your local insurance carriers as policies vary by region. The final decision for the coding of a procedure must be made by the physician considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. The SNM and its representatives disclaim any liability arising from the use of these opinions.