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Description Name Rate 38792 Injection Procedure; Radioactive Tracer for Identification of Sentinel Node 0392 5591 Q1 Q1 $280.27 $332.65 18.7%

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Description Name Rate 38792 Injection Procedure; Radioactive Tracer for Identification of Sentinel Node 0392 5591 Q1 Q1 $280.27 $332.65 18.7% WWW.SNMMI.ORG FINAL 2015 Compared to FINAL 2016 Rates Medicare Hospital Outpatient Prospective Payment System HOPPS (APC) Nuclear Medicine Procedures, Radiopharmaceuticals, and Drugs CY15 HOPPS Final Rule CY16 HOPPS Final Rule Updated 12-29-2015 version Indicator Service (Changes to status indicators for CY 2016 in Blue) Status A ● Separately Payable Clinical Diagnostic Laboratory Services Not subject to deductible or coinsurance. D Discontinued Codes Not paid under OPPS or any other Medicare payment system. Items, Codes, and Services: ● For which pricing information is not available (New in CY 2015) ● That are not covered by any Medicare outpatient benefit based on statutory exclusion (Deleted in CY 2015) Not paid by Medicare when submitted on outpatient claims (any outpatient bill E ● Not covered by any Medicare outpatient benefit category type). ● Statutorily excluded by Medicare ● Not Reasonable and necessary G Pass-Through Drug/ Biologicals Paid under OPPS; separate APC payment. NonPass-Through Drugs and nonimplantable Biologicals, including K Paid under OPPS; separate APC payment. Therapeutic Radiopharmaceuticals Paid under OPPS; payment is packaged into payment for other services. N Items and Services packaged into APC rate Therefore, there is no separate APC payment. Paid under OPPS; Addendum B displays APC assignments when services are separately payable. STV-Packaged (1) Packaged APC payment if billed on the same date of service as a HCPCS code Q1 Codes assigned status indicator “S,” “T,” or “V.” (2) In other circumstances, payment is made through a separate APC payment. S Procedure or Service, Not Discounted When Multiple Paid under OPPS; separate APC payment. T Significant Procedure, Multiple Procedure Reduction Applies Paid under OPPS; separate APC payment. U Brachytherapy Sources Paid under OPPS; separate APC payment. X Ancillary Services (Deleted in CY 2015) Paid under OPPS; separate APC payment. FINAL RULE FINAL RULE CPT/ 2015-F 2016-F 2015-F 2016-F % Trade CY 2015 CY 2016 Payment HCPCS APC APC SI SI Payment Rate Change Description Name Rate 38792 Injection procedure; radioactive tracer for identification of sentinel node 0392 5591 Q1 Q1 $280.27 $332.65 18.7% Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure) 38900 (For injection of radioactive tracer for identification of sentinel node, use N N N/A N/A N/A 38792) (Use in conjunction with 19302,19307,38500,38510, 38520,38525,38530,38542,38740,38745) Injection procedure (eg, contrast media) for evaluation of previously placed Packaged Packaged into Packaged 49427 peritoneal-venous shunt (For radiological supervision and interpretation, see N N into APC rate APC rate into APC rate 75809, 78291) Insertion of non-indwelling bladder catheter (eg, straight catheterization for 51701 0420 5734 Q1 Q1 $131.75 $91.18 -30.8% residual urine) 51702 Insertion of temporary indwelling bladder catheter; simple (eg, Foley) 0420 5734 Q1 Q1 $131.75 $91.18 -30.8% Insertion of temporary indwelling bladder catheter; complicated (eg, altered 51703 0126 5721 T SI $113.23 $129.75 14.6% anatomy, fractured catheter/balloon) Revision Date: December 29, 2015 SNMMI Reimbursement Hospital Educational Material Page 1 of 12 CPT codes copyright by the AMA www.snmmi.org Prepared by Merlino Healthcare Consulting Corp. WWW.SNMMI.ORG FINAL RULE FINAL RULE CPT/ 2015-F 2016-F 2015-F 2016-F % Trade CY 2015 CY 2016 Payment HCPCS APC APC SI SI Payment Rate Change Description Name Rate 3D rendering with interpretation and reporting of computed of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image postprocessing on an independent workstation (Use 76376 in conjunction with codes(s) for base imaging procedure(s)) Packaged Packaged into Packaged 76376 N N (Do not report 76376 in conjunction with 70496, 70498, 70544-70549, 71275, into APC rate APC rate into APC rate 71555, 72159, 72191, 72198, 73206, 73225, 73706, 73725, 74175, 74185, 75557-75564, 75635, 76377, 78000-78999, 0066T, 0067T, 0144T-0151T, 0159T) 3D rendering with interpretation and reporting of computed of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; requiring image postprocessing on an independent workstation (Use 76377 in conjunction with codes(s) for base imaging procedure(s)) Packaged Packaged into Packaged 76377 N N (Do not report 76377 in conjunction with 70496, 70498, 70544-70549, 71275, into APC rate APC rate into APC rate 71555, 72159, 72191, 72198, 73206, 73225, 73706, 73725, 74175, 74185, 75557-75564, 75635, 76376, 78000-78999, 0066T, 0067T, 0144T-0151T, 0159T) Dual-energy X-ray absorptiometry, bone density study, 1 or more sites; axial 77080 0261 5522 S S $95.02 $100.69 6.0% skeleton (eg, hips, pelvis, spine) Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more NEW 77085 sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture 5522 Q1 Q1 $95.02 $100.69 6.0% 0261 assessment NEW 77086 Vertebral fractureassessment via dual-energy X-rayabsorptiometry (DXA) 5521 Q1 Q1 $59.37 $60.80 2.4% 0260 77370 Special medical radiation physics consultation 0304 5612 S S $113.17 $166.65 47.3% NUCLEAR MEDICINE Modified in 2013 INTRODUCTORY SECTION - The services listed do not include the radiopharmaceutical or drug. To separately report supply of diagnostic and therapeutic radiopharmaceutiacls nd drugs, use the appropriate supply code(s), in addition to the procedure code. Thyroid uptake, single or multiple quantitative measurement(s) (including 78012 0389 5591 S S $189.16 $332.65 75.9% stimulation, suppression, or discharge, when performed) 78013 Thyroid imaging (including vascular flow, when performed) 0390 5591 S S $189.92 $332.65 75.2% Thyroid imaging (including vascular flow, when performed); with single or 78014 multiple uptake(s) quantitative measurement(s) (including stimulation, 0391 5591 S S $282.00 $332.65 18.0% suppression, or discharge, when performed) 78015 Thyroid carcinoma metastases imaging; limited are (eg, neck and chest only) 0406 5591 S S $377.33 $332.65 -11.8% Thyroid carcinoma metastases imaging; with additional studies (eg, urinary 78016 0406 5591 S S $377.33 $332.65 -11.8% recovery) 78018 Thyroid carcinoma metastases imaging; whole body 0406 5591 S S $377.33 $332.65 -11.8% Thyroid carcinoma metastases uptake (Use in conjunction with code 78018 Packaged Packaged into Packaged 78020 + N/A N/A N N only) into APC rate APC rate into APC rate 78070 Parathyroid planar imaging (including subtraction, when performed) 0391 5591 S S $282.00 $332.65 18.0% Parathyroid planar imaging (including subtraction, when performed); with 78071 0406 5591 S S $377.33 $332.65 -11.8% tomographic (SPECT) Parathyroid planar imaging (including subtraction, when performed); with 78072 tomographic (SPECT), and concurrently acquired computed tomography (CT) 0406 5592 S S $377.33 $441.36 17.0% for anatomical localization 78075 Adrenal imaging, cortex and/or medulla 0408 5593 S S $1,188.74 $1,108.46 -6.8% 78099 Unlisted endocrine procedure, diagnostic nuclear medicine 0390 5591 S S $189.92 $332.65 75.2% 78102 Bone marrow imaging; limited area 0400 5591 S S $369.60 $332.65 -10.0% 78103 Bone marrow imaging; multiple areas 0400 5591 S S $369.60 $332.65 -10.0% 78104 Bone marrow imaging; whole body 0400 5591 S S $369.60 $332.65 -10.0% Plasma volume, radiopharmaceutical volume-dilution technique (separate 78110 0393 5591 S S $628.19 $332.65 -47.0% procedure); single sampling Plasma volume, radiopharmaceutical volume-dilution technique (separate 78111 0393 5591 S S $628.19 $332.65 -47.0% procedure); multiple sampling 78120 Red cell volume determination (separate procedure); single sampling 0393 5591 S S $628.19 $332.65 -47.0% 78121 Red cell volume determination (separate procedure); multiple sampling 0393 5591 S S $628.19 $332.65 -47.0% Revision Date: December 29, 2015 SNMMI Reimbursement Hospital Educational Material Page 2 of 12 CPT codes copyright by the AMA www.snmmi.org Prepared by Merlino Healthcare Consulting Corp. WWW.SNMMI.ORG FINAL RULE FINAL RULE CPT/ 2015-F 2016-F 2015-F 2016-F % Trade CY 2015 CY 2016 Payment HCPCS APC APC SI SI Payment Rate Change Description Name Rate Whole blood volume determination, including separate measurement of 78122 plasma volume and red cell volume (radiopharmaceutical volume-dilution 0393 5592 S S $628.19 $441.36 -29.7% technique) 78130 Red cell survival study; 0393 5591 S S $628.19 $332.65 -47.0% Red cell survival study; differential organ/tissue kinetics (eg, splenic and/or 78135 0393 5591 S S $628.19 $332.65 -47.0% hepatic sequestration) Labeled red cell sequestration, differential organ/tissue, (eg, splenic and/or 78140 0393 5591 S S $628.19 $332.65 -47.0% hepatic) Spleen imaging only, with or without vascular flow (If combined with liver 78185 0400 5591 S S $369.60 $332.65 -10.0% study, use procedures 78215 and 78216) Kinetics, study of platelet survival, with or without differential organ/tissue 78190 0392 5593 S S $280.27 $1,108.46 295.5% localization 78191 Platelet survival study 0392 5591 S S $280.27 $332.65 18.7% Lymphatics and lymph nodes imaging (For sentinel node identification without 78195 0400 5591 S S $369.60 $332.65 -10.0% scintigraphy imaging, use 38792) Unlisted hematopoietic, Reticuloendothelial and lymphatic procedure, 78199 0400 5591 S S $369.60 $332.65 -10.0% diagnostic nuclear medicine 78201 Liver imaging; static only 0394
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