CMS Clarifies Physician and ASC Billing Rules for Implantable Tissue Markers and Implantable Radiation Dosimeters

 

Physicians may bill and receive payment for HCPCS A4648 (tissue marker, implantable, any type, each) and HCPCS A4650 (implantable radiation dosimeter each) when used with CPT codes 19499, 32553, 49411 and 55876.

 

However, ASCs and hospitals under IPPS or OPPS cannot bill for these codes as they are packaged into the payment for the service in which they are used.

 

The descriptions of the four CPT codes physicians can use to then bill for HCPCS A4648 and A4650 are:

1. 19499 (unlisted procedure, breast);
2. 32553 (placement of interstitial device(s) for radiation therapy guidance (eg., fiducial markers, dosimeter) ), percutaneous intra-thoracic, single or multiple);
3. 49411 (placement of interstitial device(s) for radiation therapy guidance (eg., fiducial markers, dosimeter), percutaneous intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple); and
4. 55876 (single or multiple((the placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter)), prostate (via needle, any approach)) on a claim for physician services.

 

For dates of service on or after Nov. 6, CMS will reimburse physicians for the two HCPCS codes when used in conjunction with one of the four CPT codes, but will deny payment if one of the above CPT codes is not paid on the same claim (or in history) with the same date of service.

 

Read the MLN Matters article clarifying payment for implantable tissue markers (pdf).

 

The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.

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