WWW.SNMMI.ORG

FINAL 2015 Compared to FINAL 2016 Rates Medicare Hospital Outpatient Prospective Payment System HOPPS (APC) Nuclear Procedures, , 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; 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 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 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 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 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 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% 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 5591 S S $373.05 $332.65 -10.8% 78202 Liver imaging; with vascular flow 0394 5591 S S $373.05 $332.65 -10.8% 78205 Liver imaging (SPECT); 0394 5591 S S $373.05 $332.65 -10.8% 78206 Liver image (SPECT); with vascular flow 0394 5591 S S $373.05 $332.65 -10.8% 78215 Liver and spleen imaging; static only 0394 5591 S S $373.05 $332.65 -10.8% 78216 Liver and spleen imaging; with vascular flow 0394 5591 S S $373.05 $332.65 -10.8% 78226 Hepatobiliary system imaging, including gallbladder when present 0394 5591 S S $373.05 $332.65 -10.8% Hepatobiliary system imaging, including gallbladder when present; with 78227 pharmacologic intervention, including quantitative measurement(s) when 0394 5591 S S $373.05 $332.65 -10.8% performed 78230 Salivary gland imaging; 0395 5591 S S $326.95 $332.65 1.7% 78231 Salivary gland imaging; with serial images 0395 5591 S S $326.95 $332.65 1.7% 78232 Salivary gland function study 0395 5591 S S $326.95 $332.65 1.7% 78258 Esophageal motility 0395 5591 S S $326.95 $332.65 1.7% 78261 Gastric mucosa imaging 0395 5591 S S $326.95 $332.65 1.7% 78262 Gastroesophageal reflux study 0395 5591 S S $326.95 $332.65 1.7% ▲ 78264 Gastric Emptying Imaging Study (eg, solid, liquid or both) 5591 5591 S S $326.95 $332.65 1.7% Gastric Emptying Imaging Study (eg, solid, liquid or both); with small bowel NEW N/A S A NA $332.65 N/A ● 78265 transit 5591 Gastric Emptying Imaging Study (eg, solid, liquid or both); with small bowel NEW N/A S S NA $441.36 N/A ● 78266 and colon transit, multiple days 5592 78267 , C-14 (isotopic); acquisition for analysis A A

78268 Urea breath test, C-14 (isotopic); analysis A A 78270 Vit B-12 absorption study (eg, Schilling test); without intrinsic factor 0392 5591 S S $280.27 $332.65 18.7% 78271 Vit B-12 absorption study (eg, Schilling test); with intrinsic factor 0392 5591 S S $280.27 $332.65 18.7% 78272 Vit B-12 absorption study combined, with and without intrinsic factor 0392 5591 S S $280.27 $332.65 18.7%

78278 Acute gastrointestinal blood loss imaging 0395 5591 S S $326.95 $332.65 1.7%

78282 Gastrointestinal protein loss 0395 5591 S S $326.95 $332.65 1.7% 78290 Intestine imaging (eg, ectopic gastric mucosa, Meckel’s localization, volvulus) 0395 5591 S S $326.95 $332.65 1.7% 78291 Peritoneal-venous shunt patency test (eg, for LeVeen, Denver shunt) 0395 5591 S S $326.95 $332.65 1.7% 78299 Unlisted gastrointestinal procedure, diagnostic nuclear medicine 0395 5591 S S $326.95 $332.65 1.7% 78300 Bone and/or joint imaging; limited area 0396 5591 S S $332.31 $332.65 0.1% 78305 Bone and/or joint imaging; multiple areas 0396 5591 S S $332.31 $332.65 0.1%

78306 Bone and/or joint imaging; whole body 0396 5591 S S $332.31 $332.65 0.1%

78315 Bone and/or joint imaging; 3 three phase study 0396 5591 S S $332.31 $332.65 0.1%

78320 Bone and/or joint imaging; tomographic (SPECT) 0396 5591 S S $332.31 $332.65 0.1% Bone density (bone mineral content) study , 1 or more sites; single 78350 E E N/A N/A N/A absorptiometry

Revision Date: December 29, 2015 SNMMI Reimbursement Hospital Educational Material Page 3 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 Bone density (bone mineral content) study , 1 or more sites; dual photon 78351 E E N/A N/A N/A absorptiometry one or more sites 78399 Unlisted musculoskeletal procedure, diagnostic nuclear medicine 0396 5591 S S $332.31 $332.65 0.1% Determination of central c-v hemodynamics (non-imagine) (eg, ejection 78414 fraction with probe technique) with or without pharmacologic intervention or 0398 5592 S S $373.56 $441.36 18.1% exercise, single or multiple determinations 78428 Cardiac shunt detection 0398 5591 S S $373.56 $332.65 -11.0%

78445 Non-cardiac vascular flow imaging (ie, angiography, venography) 0263 5591 S S $337.03 $332.65 -1.3%

Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first 78451 0377 5593 S S $1,140.54 $1,108.46 -2.8% pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first 78452 pass or gated technique, additional quantification, when performed); multiple 0377 5593 S S $1,140.54 $1,108.46 -2.8% studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional 78453 0377 5592 S S $1,140.54 $441.36 -61.3% quantification, when performed); single study, at rest or stress (exercise or pharmacologic) Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional 78454 0377 5593 S S $1,140.54 $1,108.46 -2.8% quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection

78456 Acute venous thrombus imaging, peptide 0317 5593 S S $813.20 $1,108.46 36.3%

78457 Venous thrombosis imaging, venogram; unilateral 0263 5592 S S $337.03 $441.36 31.0%

78458 Venous thrombosis imaging, venogram; bilateral 0263 5591 S S $337.03 $332.65 -1.3% Myocardial imaging, emission tomography (PET), metabolic 78459 0308 5594 S S $1,286.23 $1,285.17 -0.1% evaluation

78466 Myocardial imaging, infarct avid, planar; qualitative or quantitative 0398 5591 S S $373.56 $332.65 -11.0%

Myocardial imaging, infarct avid, planar; with ejection fraction by first pass 78468 0398 5591 S S $373.56 $332.65 -11.0% technique Myocardial imaging, infarct avid, planar; tomographic SPECT with or without 78469 0398 5592 S S $373.56 $441.36 18.1% quantification Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection 78472 0398 5591 S S $373.56 $332.65 -11.0% fraction, with or without additional quantitative processing (or assessment of cardiac function by first pass technique, use 78496) Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion 78473 study plus ejection fraction, at rest and stress (exercise and/or 0398 5591 S S $373.56 $332.65 -11.0% pharmacologic), with or without additional quantification Cardiac blood pool imaging (planar), first pass technique; single study, at rest 78481 or with stress (exercise and/or pharmacologic), wall motion study plus 0398 5592 S S $373.56 $441.36 18.1% ejection fraction, with or without quantification Cardiac blood pool imaging (planar), first pass technique; multiple studies, at 78483 rest and with stress (exercise and/or pharmacologic), wall motion study plus 0377 5592 S S $1,140.54 $441.36 -61.3% ejection fraction, with or without quantification

Myocardial imaging, tomography (PET), perfusion; single 78491 0308 5594 S S $1,286.23 $1,285.17 -0.1% study at rest or stress

Myocardial imaging, positron emission tomography (PET), perfusion; multiple 78492 0308 5594 S S $1,286.23 $1,285.17 -0.1% studies at rest and/or stress Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion 78494 0398 5591 S S $373.56 $332.65 -11.0% study plus ejection fraction, with or without quantitative processing Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right Packaged Packaged into Packaged 78496 + ventricular ejection fraction by first pass technique (Use 78496 in conjunction N N into APC rate APC rate into APC rate with 78472) 78499 Unlisted cardiovascular procedure, diagnostic nuclear medicine 0398 5591 S S $373.56 $332.65 -11.0% Myocardial sympathetic innervation, imaging, planar qualitative 0331T 0377 5593 S S $1,140.54 $1,108.46 -2.8% assessment

Revision Date: December 29, 2015 SNMMI Reimbursement Hospital Educational Material Page 4 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 Myocardial sympathetic innervation, imaging, planar qualitative and 0332T 0377 5593 S S $1,140.54 $1,108.46 -2.8% quantitative assessment; with tomographic SPECT

78579 Pulmonary ventilation imaging (eg, aerosol or gas) 0401 5591 S S $315.89 $332.65 5.3%

78580 Pulmonary perfusion imaging (eg, particulate) 0401 5591 S S $315.89 $332.65 5.3%

78582 Pulmonary ventilation imaging (eg, aerosol or gas) and perfusion imaging 0378 5592 S S $440.34 $441.36 0.2% Quantitative differential pulmonary perfusion, including imaging when 78597 0401 5591 S S $315.89 $332.68 5.3% performed Quantitative differential pulmonary perfusion and ventilation (eg aerosol or 78598 0378 5592 S S $440.34 $441.36 0.2% gas), including imaging when performed 78599 Unlisted respiratory procedure, diagnostic nuclear medicine 0401 5591 S S $315.89 $332.65 5.3% 78600 Brain imaging, less than 4 static views; 0403 5591 S S $177.06 $332.65 87.9% 78601 Brain imaging, less than 4 static views; with vascular flow 0402 5591 S S $557.25 $332.65 -40.3%

78605 Brain imaging, minimum 4 static views; 0402 5592 S S $557.25 $441.36 -20.8%

78606 Brain imaging, minimum 4 static views; with vascular flow 0402 5592 S S $557.25 $441.36 -20.8%

78607 Brain imaging, tomographic (SPECT) 0408 5593 S S $1,188.74 $1,108.46 -6.8%

78608 Brain imaging, positron emission tomography (PET); metabolic evaluation 0308 5594 S S $1,286.23 $1,285.17 -0.1%

78609 Brain imaging, positron emission tomography (PET); perfusion evaluation E E N/A N/A NA

78610 Brain imaging, vascular flow only 0402 5591 S S $557.25 $332.65 -40.3% Cerebrospinal fluid flow, imaging (not including introduction of material); 78630 0402 5592 S S $557.25 $441.36 -20.8% cisternography (For injection procedure, see 61000-61070, 62270-62319)

Cerebrospinal fluid flow, imaging (not including introduction of material); 78635 0402 5592 S S $557.25 $441.36 -20.8% ventriculography (For injection procedure, see 61000-61070, 62270-62294)

Cerebrospinal fluid flow, imaging (not including introduction of material); 78645 0402 5591 S S $557.25 $332.65 -40.3% shunt evaluation (For injection procedure, see 61000-61070, 62270-62294)

Cerebrospinal fluid flow, imaging (not including introduction of material); 78647 0402 5593 S S $557.25 $1,108.46 98.9% tomographic (SPECT) 78650 Cerebrospinal fluid leakage detection and localization 0402 5593 S S $557.25 $1,108.46 98.9% 78660 Radiopharmaceutical dacryocystography 0403 5591 S S $177.06 $332.65 87.9%

78699 Unlisted nervous system procedure, diagnostic nuclear medicine 0403 5591 S S $177.06 $332.65 87.9%

78700 imaging morphology 0404 5591 S S $420.66 $332.65 -20.9%

78701 Kidney imaging morphology with vascular flow 0404 5591 S S $420.66 $332.65 -20.9% Kidney imaging morphology with vascular flow and function, single study 78707 0404 5592 S S $420.66 $441.36 4.9% without pharmacological intervention Kidney imaging morphology with vascular flow and function, single study, with 78708 pharmacological intervention (eg, angiotensin converting enzyme inhibitor 0404 5592 S S $420.66 $441.36 4.9% and/or diuretic) Kidney imaging morphology with vascular flow and function, multiple studies, 78709 with and without pharmacological intervention (eg, angiotensin converting 0404 5592 S S $420.66 $441.36 4.9% enzyme inhibitor and/or diuretic) 78710 Kidney imaging morphology tomographic (SPECT) 0404 5592 S S $420.66 $441.36 4.9%

78725 Kidney function study, non-imaging radioisotopic study 0392 5661 S S $280.27 $249.98 -10.8%

Urinary bladder residual study (List separately in addition to code for primary procedure) (Use 78730 in conjunction with 78740) (For measurement of Packaged Packaged into Packaged 78730 + postvoid residual urine and/or bladder capacity by ultrasound, nonimaging, N N into APC rate APC rate into APC rate use 51798) (For ultrasound imaging of the bladder only, with measurement of postvoid residual urine when performed, use 76857)

Ureteral reflux study (radiopharmaceutical voiding cystogram) For 78740 0404 5591 S S $420.66 $332.65 -20.9% catheterization see 51701, 51702, 51703

78761 Testicular imaging with vascular flow 0404 5591 S S $420.66 $332.65 -20.9%

78799 Unlisted genitourinary procedure; diagnostic nuclear medicine 0404 5591 S S $420.66 $332.65 -20.9%

Revision Date: December 29, 2015 SNMMI Reimbursement Hospital Educational Material Page 5 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 Radiopharmaceutical localization of tumor or distribution of 78800 0406 5591 S S $377.33 $332.65 -11.8% radiopharmaceutical agent(s); limited area Radiopharmaceutical localization of tumor or distribution of 78801 0406 5591 S S $377.33 $332.65 -11.8% radiopharmaceutical agent(s); multiple areas Radiopharmaceutical localization of tumor or distribution of 78802 0414 5592 S S $706.73 $441.36 -37.5% radiopharmaceutical agent(s); whole body, single day imaging Radiopharmaceutical localization of tumor or distribution of 78803 0414 5592 S S $706.73 $441.36 -37.5% radiopharmaceutical agent(s); tomographic (SPECT)

Radiopharmaceutical localization of tumor or distribution of 78804 0408 5593 S S $1,188.74 $1,108.46 -6.8% radiopharmaceutical agent(s); whole body, requiring 2 or more days imaging

78805 Radiopharmaceutical localization of inflammatory process; limited area 0414 5593 S S $706.73 $1,108.46 56.8%

78806 Radiopharmaceutical localization of inflammatory process; whole body 0414 5593 S S $706.73 $1,108.46 56.8%

Radiopharmaceutical localization of inflammatory process; tomographic 78807 (SPECT) (For imaging bone infectious or inflammatory disease with a bone 0414 5592 S S $706.73 $441.36 -37.5% imaging radiopharmaceutical, see 78300, 78305, 78306) Injection procedure for radiopharmaceutical localization by non-imaging probe 78808 study, intravenous (eg, parathyroid adenoma) 0392 5591 Q1 Q1 $280.27 $332.65 18.7% (For sentinel lymph node identification, use 38792) Positron emission tomography (PET) imaging; limited area (eg. chest, 78811 0308 5594 S S $1,286.23 $1,285.17 -0.1% head/neck) 78812 Positron emission tomography (PET) imaging; skull base to mid-thigh 0308 5594 S S $1,286.23 $1,285.17 -0.1% 78813 Positron emission tomography (PET) imaging; whole body 0308 5594 S S $1,286.23 $1,285.17 -0.1% Positron emission tomography (PET) with concurrently acquired computed 78814 tomography (CT) for attenuation correction and anatomical localization 0308 5594 S S $1,286.23 $1,285.17 -0.1% imaging; limited area (eg, chest, head/neck) Positron emission tomography (PET) with concurrently acquired computed 78815 tomography (CT) for attenuation correction and anatomical localization 0308 5594 S S $1,286.23 $1,285.17 -0.1% imaging; skull base to mid-thigh Positron emission tomography (PET) with concurrently acquired computed 78816 tomography (CT) for attenuation correction and anatomical localization 0308 5594 S S $1,286.23 $1,285.17 -0.1% imaging; whole body (Report 78811-78816 only once per imaging session) (Computed tomography (CT) performed for other than attenuation correction and anatomical localization is reported using the appropriate site specific CT code with modifier 59)

78999 Unlisted miscellaneous procedure, diagnostic nuclear medicine 0389 5591 S S $189.16 $332.65 75.9% C9898 Radiolabeled product provided during a hospital inpatient stay N N N/A N/A NA Radiopharmaceutical therapy, by oral administration (For monoclonal 79005 0407 5561 S S $276.93 $249.98 -9.7% antibody by intravenous infusion, use 79403) Radiopharmaceutical therapy, by intravenous administration (Do not report 79101 in conjunction with 36400, 35410, 79403, 90780, 96408) (For 79101 monoclonal antibody by intravenous infusion, use 79403) (For infusion or 0407 5561 S S $276.93 $249.98 -9.7% instillation of non-antibody radioelement solution that includes three months follow-up care, use 77750) 79200 Radiopharmaceutical therapy, by intracavitary administration 0407 5561 S S $276.93 $249.98 -9.7%

79300 Radiopharmaceutical therapy, by interstitial radioactive colloid administration 0407 5561 S S $276.93 $249.98 -9.7%

Radiopharmaceutical therapy, radiolabeled monoclonal antibody by 79403 intravenous infusion (For pre-treatment imaging, see 78802, 78804) (Do not 0407 5561 S S $276.93 $249.98 -9.7% use in conjunction with 79101)

79440 Radiopharmaceutical therapy, by intra-articular administration 0407 5561 S S $276.93 $249.98 -9.7%

Radiopharmaceutical therapy, by intra-arterial particulate administration (Do not report 79445 in conjunction with 90783, 96420) (Use appropriate 79445 procedural and radiological supervision and interpretation codes for the 0407 5561 S S $276.93 $249.98 -9.7% angiographic and interventional procedures provided pre-requisite to intra- arterial radiopharmaceutical therapy)

79999 Radiopharmaceutical therapy, unlisted procedure 0407 5561 S S $276.93 $249.98 -9.7% Cardiovascular stress test using maximal or submaximal treadmill or bicycle 93017 exercise, continuous electrocardiographic monitoring, and/or pharmacological 0100 5722 Q1 Q1 $238.04 $220.35 -7.4% stress; tracing only, without interpretation and report

Revision Date: December 29, 2015 SNMMI Reimbursement Hospital Educational Material Page 6 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 Chemotherapy administration, intravenous infusion technique; up to one 96413 0440 5695 S S $285.11 $280.27 -1.7% hour, single or initial substance/drug

G0219 PET imaging whole body; melanoma for non-covered indications E E NA

G0235 PET IMAGING, ANY SITE, NOT OTHERWISE SPECIFIED E E NA PET imaging, full & partial-ring PET scanner only, for initial diagnosis of G0252 breast cancer and/or surgical planning for breast cancer (eg, initial staging of E E NA axillary lymph nodes)

CY 2015 CY 2016 RADIOPHARMACEUTICALS & NUCLEAR MEDICINE RELATED DRUGS % Change FINAL FINAL

Non-HEU TC-99M Add-On per study dose 95 percent NON- Q9969 Tc-99m from non-highly enriched uranium source, full cost 1442 1442 K K $10.00 $10.00 $0.00 HEU Product recovery add-on, per study dose

Radiopharm dx agent noc Packaged Packaged into Packaged A4641 RADIOPHARMACEUTICAL, DIAGNOSTIC, NOT NOC N N into APC rate APC rate into APC rate OTHERWISE CLASSIFIED In111 satumomab IN-111 SATUMOMAB PENDETIDE, Packaged Packaged into Packaged A4642 ONCOSCINT® N N DIAGNOSTIC, PER STUDY DOSE, UP TO 6 into APC rate APC rate into APC rate MILLICURIES Tc99m sestamibi CARDIOLITE® / Packaged Packaged into Packaged A9500 TC-99M SESTAMIBI, DIAGNOSTIC, PER N N MIRALUMA® into APC rate APC rate into APC rate STUDY DOSE, UP TO 40 MILLICURIES

Technetium TC-99m teboroxime TECHNETIUM TC-99M TEBOROXIME, DIAGNOSTIC, CardioTec® Packaged Packaged into Packaged A9501 N N PER STUDY DOSE TEBO into APC rate APC rate into APC rate

Tc99m tetrofosmin Packaged Packaged into Packaged A9502 TECHNETIUM TC-99M TETROFOSMIN, DIAGNOSTIC, MYOVIEW® N N into APC rate APC rate into APC rate PER STUDY DOSE Tc99m medronate

TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, Packaged Packaged into Packaged A9503 MDP N N PER STUDY DOSE, UP TO 30 MILLICURIES into APC rate APC rate into APC rate

Tc99m apcitide

TECHNETIUM TC-99M APCITIDE, DIAGNOSTIC, PER Packaged Packaged into Packaged A9504 ACUTECT® N N STUDY DOSE, UP TO 20 MILLICURIES into APC rate APC rate into APC rate

TL201 thallium Packaged Packaged into Packaged A9505 THALLIUM 201 N N THALLIUM TL-201 THALLOUS CHLORIDE, into APC rate APC rate into APC rate DIAGNOSTIC, PER MILLICURIE

In111 capromab Packaged Packaged into Packaged A9507 PROSTASCINT® N N INDIUM IN-111 CAPROMAB PENDETIDE, DIAGNOSTIC, into APC rate APC rate into APC rate PER STUDY DOSE, UP TO 10 MILLICURIES

I131 iodobenguate, dx Packaged Packaged into Packaged A9508 I-131 MIBG N N I-131 SULFATE, DIAGNOSTIC, into APC rate APC rate into APC rate PER 0.5 MILLICURIE Use for 1-4 mCi Iodine I-123 sod iodide mil doses of I-123 for whole body imaging Packaged Packaged into Packaged A9509 N N IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER for less than 1 mCi into APC rate APC rate into APC rate MILLICURIE and thyroid imaging see A9516 Tc99m disofenin Packaged Packaged into Packaged A9510 TECHNETIUM TC-99M DISOFENIN, DIAGNOSTIC, PER DISIDA N N into APC rate APC rate into APC rate STUDY DOSE, UP TO 15 MILLICURIES

Revision Date: December 29, 2015 SNMMI Reimbursement Hospital Educational Material Page 7 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 Straight Tech Tc99m TECHNETIUM TC- Packaged Packaged into Packaged A9512 Technescan N N 99M PERTECHNETATE, DIAGNOSTIC, PER MILLICURIE into APC rate APC rate into APC rate Technelite

Dx I-123 Capsules. Use for A9516 for Iodine I-123 sod iodide mCi Thyroid uptakes and IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER 100 Packaged Packaged into Packaged A9516 scans, for 1 mCi and N N MICROCURIES, UP TO 999 MICROCURIES into APC rate APC rate into APC rate greater and whole body imaging see A9509

I131 iodide cap, rx Rx I-131 A9517 IODINE I-131 SODIUM IODIDE CAPSULE(S), 1064 1064 K K $40.70 $40.70 0.0% Capsules THERAPEUTIC, PER MILLICURIE Tc99 Tilmanocept Diag 0.5MCI Off Pass- Packaged into A9520 TECHNETIUM TC-99M TILMANOCEPT, DIAGNOSTIC, Lymphoseek™ 1463 G N $240.00 100.0% through APC rate UP TO 0.5 MILLICURIES Tc99m exametazime CERETEC® Packaged Packaged into Packaged A9521 TECHNETIUM TC-99M EXAMETAZIME, DIAGNOSTIC, N N HMPAO into APC rate APC rate into APC rate PER STUDY DOSE, UP TO 25 MILLICURIES I131 serum albumin, dx Packaged Packaged into Packaged A9524 IODINE I-131 IODINATED SERUM ALBUMIN, I-131 Albumin N N into APC rate APC rate into APC rate DIAGNOSTIC, PER 5 MICROCURIES Nitrogen N-13 ammonia Packaged Packaged into Packaged A9526 NITROGEN N-13 AMMONIA, DIAGNOSTIC, PER STUDY N-13 N N into APC rate APC rate into APC rate DOSE, UP TO 40 MILLICURIES Iodine I-125 sodium iodide A9527 IODINE I-125, SODIUM IODIDE SOLUTION, 2632 2632 U U $13.25 $7.14 -46.1% THERAPEUTIC, PER MILLICURIE Iodine I-131 iodide cap, dx I-131 Dx caps Packaged Packaged into Packaged A9528 IODINE I-131 SODIUM IODIDE CAPSULE(S), N N per mCi into APC rate APC rate into APC rate DIAGNOSTIC, PER MILLICURIE I131 iodide sol, dx Dx I-131 sol per Packaged Packaged into Packaged A9529 IODINE I-131 SODIUM IODIDE SOLUTION, DIAGNOSTIC, N N mCi into APC rate APC rate into APC rate PER MILLICURIE

I131 iodide sol, rx Rx I-131 sol per A9530 IODINE I-131 SODIUM IODIDE SOLUTION, 1150 1150 K K $10.28 $10.28 0.0% mCi THERAPEUTIC, PER MILLICURIE

I131 max 100uCi Dx I-131 up to Packaged Packaged into Packaged A9531 IODINE I-131 SODIUM IODIDE, DIAGNOSTIC, PER N N 100 uCi into APC rate APC rate into APC rate MICROCURIE (UP TO 100 MICROCURIES) I125 serum albumin, dx Packaged Packaged into Packaged A9532 IODINE I-125 SERUM ALBUMIN, DIAGNOSTIC, PER 5 N N into APC rate APC rate into APC rate MICROCURIES Tc99m depreotide TECHNETIUM TC-99M DEPREOTIDE, DIAGNOSTIC, Packaged Packaged into Packaged A9536 NEOTEC® N N PER STUDY DOSE, UP TO 35 MILLICURIES into APC rate APC rate into APC rate

Tc99m mebrofenin TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, Packaged Packaged into Packaged A9537 CHOLETEC® N N PER STUDY DOSE, UP TO 15 MILLICURIES into APC rate APC rate into APC rate

PYROLITE® *Use this code for Tc99m pyrophosphate myocardial infarct TECHNETIUM TC-99M PYROPHOSPHATE, imaging. Do not use Packaged Packaged into Packaged A9538 DIAGNOSTIC, PER STUDY DOSE, UP TO 25 N N this code for GBP, into APC rate APC rate into APC rate MILLICURIES RVG or MUGA procedures see A9560

Tc99m pentetate Packaged Packaged into Packaged A9539 Tc-99m DTPA N N TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER into APC rate APC rate into APC rate STUDY DOSE, UP TO 25 MILLICURIES

Revision Date: December 29, 2015 SNMMI Reimbursement Hospital Educational Material Page 8 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 Tc99m MAA Packaged Packaged into Packaged A9540 TECHNETIUM TC-99M MACROAGGREGATED MAA N N into APC rate APC rate into APC rate ALBUMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES Tc99m colloid SULFUR Packaged Packaged into Packaged A9541 TECHNETIUM TC-99M SULFUR COLLOID, N N COLLOID® (SC) into APC rate APC rate into APC rate DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES In111 ibritumomab, dx Dx In-111 Packaged Packaged into Packaged A9542 N N INDIUM IN-111 IBRITUMOMAB TIUXETAN, DIAGNOSTIC, ZEVALIN® into APC rate APC rate into APC rate PER STUDY DOSE, UP TO 5 MILLICURIES Y90 ibritumomab, rx Rx Y-90 A9543 YTTRIUM Y-90 IBRITUMOMAB TIUXETAN, 1643 1643 K K $43,892.48 $46,304.42 5.5% ZEVALIN® THERAPEUTIC, PER TREATMENT DOSE, UP TO 40 MILLICURIES I131 tositumomab, dx Packaged Packaged into Packaged A9544 Dx BEXXAR® N N IODINE I-131 TOSITUMOMAB, DIAGNOSTIC, PER into APC rate APC rate into APC rate STUDY DOSE I131 tositumomab, rx Packaged Packaged into Packaged A9545 Rx BEXXAR® E E IODINE I-131 TOSITUMOMAB, THERAPEUTIC, PER into APC rate APC rate into APC rate TREATMENT DOSE Co57/58 Packaged Packaged into Packaged A9546 NYCOMED N N CO-57/58, CYANOCOBALAMIN, DIAGNOSTIC, into APC rate APC rate into APC rate PER STUDY DOSE, UP TO 1 MICROCURIE See new codes In111 oxyquinoline A9570 and A9571 for Packaged Packaged into Packaged A9547 INDIUM IN-111 OXYQUINOLINE, DIAGNOSTIC, PER 0.5 N N WBC and Platelet into APC rate APC rate into APC rate MILLICURIE Imaging

In111 pentetate Packaged Packaged into Packaged A9548 INDIUM IN-111 PENTETATE, DIAGNOSTIC, PER 0.5 Indium DTPA N N into APC rate APC rate into APC rate MILLICURIE

Tc99m gluceptate TECHNETIUM TC-99M SODIUM GLUCEPTATE, Packaged Packaged into Packaged A9550 GLUCOSCAN® N N DIAGNOSTIC, PER STUDY DOSE, UP TO 25 into APC rate APC rate into APC rate MILLICURIES

Tc99m succimer Packaged Packaged into Packaged A9551 TECHNETIUM TC-99M SUCCIMER, DIAGNOSTIC, PER DMSA N N into APC rate APC rate into APC rate STUDY DOSE, UP TO 10 MILLICURIES F18 fdg Packaged Packaged into Packaged A9552 F-18 FDG, DIAGNOSTIC, FDG / F-18 N N into APC rate APC rate into APC rate PER STUDY DOSE, UP TO 45 MILLICURIES Cr51 chromate Packaged Packaged into Packaged A9553 CHROMIUM CR-51 SODIUM CHROMATE, DIAGNOSTIC, N N into APC rate APC rate into APC rate PER STUDY DOSE, UP TO 250 MICROCURIES I125 iothalamate, dx IODINE I-125 SODIUM IOTHALAMATE, DIAGNOSTIC, Packaged Packaged into Packaged A9554 N N PER STUDY DOSE, UP TO 10 MICROCURIES into APC rate APC rate into APC rate Rb82 rubidium Rb-82 Packaged Packaged into Packaged A9555 RUBIDIUM RB-82, DIAGNOSTIC, PER STUDY DOSE, UP N N CardioGen82 into APC rate APC rate into APC rate TO 60 MILLICURIES

Ga67 gallium Packaged Packaged into Packaged A9556 GALLIUM GA-67 CITRATE, DIAGNOSTIC, PER GALLIUM N N into APC rate APC rate into APC rate MILLICURIE

Tc99m bicisate Packaged Packaged into Packaged A9557 TECHNETIUM TC-99M BICISATE, DIAGNOSTIC, PER NEUROLITE® N N into APC rate APC rate into APC rate STUDY DOSE, UP TO 25 MILLICURIES

Xe133 xenon 10mci Packaged Packaged into Packaged A9558 XENON XE-133 GAS, DIAGNOSTIC, PER 10 Xenon N N into APC rate APC rate into APC rate MILLICURIES

Revision Date: December 29, 2015 SNMMI Reimbursement Hospital Educational Material Page 9 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 Co57 cyano COBALT CO-57 CYANOCOBALAMIN, ORAL, Shillings Study Packaged Packaged into Packaged A9559 DIAGNOSTIC, PER STUDY DOSE, UP TO 1 Rubratope 57 N N into APC rate APC rate into APC rate MICROCURIE Cobatope 57

ULTRATAG® or Tc99m labeled rbc Cold PYP + 99m Tc TECHNETIUM TC-99M LABELED RED BLOOD CELLS, Code to be used for Packaged Packaged into Packaged A9560 DIAGNOSTIC, PER STUDY DOSE, UP TO 30 N N both the invivo/invitro into APC rate APC rate into APC rate MILLICURIES methods of tagging Red Blood Cells

Tc99m oxidronate TECHNETIUM TC-99M OXIDRONATE, DIAGNOSTIC, Packaged Packaged into Packaged A9561 HDP® N N PER STUDY DOSE, UP TO 30 MILLICURIES into APC rate APC rate into APC rate

Tc99m mertiatide TECHNETIUM TC-99M MERTIATIDE, DIAGNOSTIC, PER Packaged Packaged into Packaged A9562 MAG-3® N N STUDY DOSE, UP TO 15 MILLICURIES into APC rate APC rate into APC rate

P32 Na A9563 SODIUM PHOSPHATE P-32, THERAPEUTIC, PER 1675 1675 K K $213.56 $213.56 0.0% MILLICURIE

P32 chromic phosphate Phosphocol P- A9564 CHROMIC PHOSPHATE P-32 SUSPENSION, 1676 1676 K K $906.62 $906.62 0.0% 32 THERAPEUTIC, PER MILLICURIE

Tc99m fanolesomab Packaged Packaged into Packaged A9566 TECHNETIUM TC-99M FANOLESOMAB, DIAGNOSTIC, NeutroSpec™ N N into APC rate APC rate into APC rate PER STUDY DOSE, UP TO 25 MILLICURIES DTPA Aerosol Technetium TC-99m aerosol For Lung Packaged Packaged into Packaged A9567 TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, N N Ventilation into APC rate APC rate into APC rate AEROSOL, PER STUDY DOSE, UP TO 75 MILLICURIES Studies

Technetium tc99m arcitumomab Packaged Packaged into Packaged A9568 TECHNETIUM TC-99M ARCITUMOMAB, DIAGNOSTIC, CEA-SCAN® N N into APC rate APC rate into APC rate PER STUDY DOSE, UP TO 45 MILLICURIES

Use this code for Technetium TC-99m auto WBC or TECHNETIUM TC-99M EXAMETAZIME LABELED imaging Packaged Packaged into Packaged A9569 AUTOLOGOUS WHITE BLOOD CELLS, DIAGNOSTIC, N N do not use this code into APC rate APC rate into APC rate PER STUDY DOSE for brain imaging see A9521

Indium In-111 auto WBC When prepared with 'INDIUM IN-111 LABELED AUTOLOGOUS WHITE patient WBC use this Packaged Packaged into Packaged A9570 N N BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE new code do not use into APC rate APC rate into APC rate A9547

Indium IN-111 auto platelet When prepared with INDIUM IN-111 LABELED AUTOLOGOUS PLATELETS, patient platelets use Packaged Packaged into Packaged A9571 N N DIAGNOSTIC, PER STUDY DOSE this new code do not into APC rate APC rate into APC rate use A9547

Indium In-111 pentetreotide 'INDIUM IN-111 PENTETREOTIDE, DIAGNOSTIC, PER Packaged Packaged into Packaged A9572 Octreoscan® N N STUDY DOSE, UP TO 6 MILLICURIES into APC rate APC rate into APC rate

Sodium Fluoride F-18, F-18, NaF, Packaged Packaged into Packaged A9580 F-18, diagnostic, per study dose, up to 30 N N Sodium Fluoride into APC rate APC rate into APC rate millicuries

I-123 MIBG Iobenguane, I-123, diagnostic, per study dose, up to 15 Packaged Packaged into Packaged A9582 AdreView NDC N N millicuries into APC rate APC rate into APC rate 17156-0235-01

Iodine I-123 , diagnostic, per study dose, (up to 5 DaTscan® NDC Packaged Packaged into Packaged A9584 N N millicuries) #17156-210-01 into APC rate APC rate into APC rate

Revision Date: December 29, 2015 SNMMI Reimbursement Hospital Educational Material Page 10 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 F18 FLORBETAPIR F18, DIAGNOSTIC, PER STUDY DOSE, Amyvid™ NDC A9586 1664 1664 G G $2,756.00 $2,756.00 0.0% UP TO 10 MILLICURIES #0002-1200-01

Neuraceq™ F-18 ● C9458 F-18, diagnostic per study does, up to 8.1 florbetaben - New Packaged N/A K G $2,968.00 N/A *A9599 millicuries Piramal NDC # 9458 into APC rate 54828-001-30

Vizamyl™ F-18 ● C9459 F-18, diagnostic, per study dose, up to 5 flutemetamol - New Packaged N/A N G $3,135.00 N/A *A9599 millicuries G.E. NDC # 9459 into APC rate 17156-067-01 Sr89 strontium STRONTIUM SR-89 CHLORIDE, THERAPEUTIC, PER A9600 Rx METASTRON® 0701 0701 K K $1,178.28 $1,160.34 -1.5% MILLICURIE Sm 153 lexidronm SAMARIUM SM-153 LEXIDRONAMM, THERAPEUTIC, A9604 Rx QUADRAMET® 1295 1295 K K $8,476.77 $10,962.42 29.3% PER TREATMENT DOSE, up to 150 MILLICURIES Radium Ra-223 dichloride, therapeutic, per microcurie Xofigo™ NDC A9606 1745 1745 K K $120.65 $112.30 -6.9% dose #50419-0208-01 Radiopharm rx agent noc RADIOPHARMACEUTICAL, THERAPEUTIC, NOT Packaged Packaged into Packaged A9699 RX NOC N N OTHERWISE CLASSIFIED into APC rate APC rate into APC rate

**Note final payment rates for status G codes have offset RP amounts posted on the CMS web site by CPT code. ADENOSCAN Packaged Packaged into Packaged J0153 Adenosine inj 1mg Replaces J0150, N N into APC rate APC rate into APC rate J0151 and J0152 Packaged Packaged into Packaged J0280 Aminophyllin up to 250 MG, inj. N N into APC rate APC rate into APC rate Packaged Packaged into Packaged J0461 Inj, atropine sulfate, 0.01 mg N N into APC rate APC rate into APC rate Packaged Packaged into Packaged J1120 Acetazolamide sodium injection, up to 500 mg Diamox N N into APC rate APC rate into APC rate Packaged Packaged J1160 Inj, digoxin, up to 0.5 mg Lanoxin 1834 N K $114.94 into APC rate into APC rate Packaged Packaged into Packaged J1245 Dipyridamole injection, per 10mg Persantine IV N N into APC rate APC rate into APC rate Packaged Packaged into Packaged J1250 Inj dobutamine HCL/250 mg Dobutrex N N into APC rate APC rate into APC rate Packaged Packaged into Packaged J1265 Injection, dopamine HCl, 40 mg Intropin N N into APC rate APC rate into APC rate J1610 Glucagon hydrochloride per 1MG Glucagen 9042 9042 K K $162.08 $190.60 17.6% Packaged Packaged into Packaged J1800 Propranolol HCL injection, up to 1 mg Inderal N N into APC rate APC rate into APC rate Packaged Packaged into Packaged J1940 Furosemide injection up to 20 mg Lasix N N into APC rate APC rate into APC rate

Packaged Packaged into Packaged J2270 Morphine sulfate injection, up to 10 mg Replaces J2271 N N into APC rate APC rate into APC rate

LexiScan NDC Packaged Packaged into Packaged J2785 Injection, Regadenoson, 0.1 milligrams N N 00469-6501-89 into APC rate APC rate into APC rate

Sincalide injection Packaged Packaged into Packaged J2805 Kinevac® N N INJECTION, SINCALIDE, 5 MICROGRAMS into APC rate APC rate into APC rate Thyrogen J3240 Thyrotropin injection 0.9 mg n 1.1 mg vial 9108 9108 K K $1,428.67 $1,432.17 0.2% Thytropar Packaged Packaged into Packaged J3420 Injection, vitamin B-12 cyanocobalamin, up to 1000 mcg N N into APC rate APC rate into APC rate Packaged Packaged into Packaged J3490 Drugs Unclassified injection NOC N N into APC rate APC rate into APC rate Packaged Packaged into Packaged J3590 Unclassified biologics NOC N N into APC rate APC rate into APC rate Packaged Packaged into Packaged J7030 Normal saline solution infus (1000 CC) N N into APC rate APC rate into APC rate

Revision Date: December 29, 2015 SNMMI Reimbursement Hospital Educational Material Page 11 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 Packaged Packaged into Packaged J7040 Normal saline solution infus (500ML=1) N N into APC rate APC rate into APC rate Packaged Packaged into Packaged J7050 Normal saline solution infus (250 CC) N N into APC rate APC rate into APC rate J9310 Rituximab, 100 mg RituXan 0849 0849 K K $725.44 $748.70 3.2%

Non Radioactive Admin + supply, tositumomab, 450 mg G3001 Bexxar Plus 0442 5701 S S $1,151.59 $1,971.61 71.2% (Use this Code for Bexxar) Injection Injection, non-radioactive, non-contrast, visualization Q9968 Methylene Blue 1446 1446 K K $1.61 $10.80 569.1% adjunct (e.g., Methylene Blue, Isosulfan Blue), 1mg

Disclaimer The opinions referenced are those of the members of the SNMMI 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 SNMMI and its representatives disclaim any liability arising from the use of these opinions. Legend: ▲ Blue triangle - current code revision has resulted in a substantially altered procedure descriptor ● Red circle - new procedure

Revision Date: December 29, 2015 SNMMI Reimbursement Hospital Educational Material Page 12 of 12 CPT codes copyright by the AMA www.snmmi.org Prepared by Merlino Healthcare Consulting Corp.