Marlene Posted Tue 17th of March, 2020 10:13:47 AM
We use Persantine or Dipyridamole on our in house nuclear cardiology studies The code is J1245 and we use either 4 or 6 units per patient each study depending on weight of that patient. The cost is very high 129.40 for a box of 5 vials so this comes out to be 25.88 per patient give or take a few cents or dollars. The reimbursement from Medicare is horrible. On each patient the charge can be up to 90.00 and they reimburse like $.32 cents and state this is ASP. We do not know if we are billing it right and need help The box is for Dipyridamole Injection 50 mg/10 ml (5mg/ml.) for IV use. states 5 x 10 ml single dose vials. Can someone help us that is familiar with this type of billing as we are now questioning ourselves
SuperCoder Answered Wed 18th of March, 2020 07:29:30 AM
Thank you for your Question
As per CMS, the MUE of this code is 6, however, CMS has also acknowledged that circumstances can occur when units greater than the MUE limit would be appropriate.
The recommended intravenous dosage in an adult is 0.57 mg/kg IV administered at a rate of 0.142 mg/kg/minute for 4 minutes. The maximum dose is 60 mg. The radiopharmaceutical is injected within 3—4 minutes after the dipyridamole infusion.
Note: Under the ASP payment system, Medicare pays providers ASP+6 percent for the drug. ASP reflects the average price realized by the manufacturer for its sales broadly across different types of purchasers and for patients with different types of insurance coverage. It is based on manufacturers’ sales to all purchasers net of manufacturer rebates, discounts, and price concessions (with certain exceptions).
Since, there is a payment limit assigned to this code, you are requested to get in touch with your respective payer for any specific reimbursement guidelines for J1245; if any.
Feel free to ask if you have any questions,