IDEAS Study – PET Facilities – Medicare Reimbursement Information – 4.26.2016

TO: IDEAS Study PET imaging facility administrators (please forward as needed)

• Sample Medicare Claims and a Site Checklist have now been posted to the IDEAS website at: the forms page.

• Novitas Solutions, Inc. important guidelines affecting the IDEAS Study

Effective on April 20, 2016 Novitas has updated the claims processing system related to Positron Emission Tomography (PET) Beta Amyloid Imaging (PET Aβ Imaging) for CPT codes 78811 or78814. This means that IDEAS sites may resubmit previously denied claims and submit any held claims for processing. If you continue to receive denials of claims submitted after April 20, 2016 date, please inform IDEAS.

If your PET facility is an Independent Diagnostic Testing Facility (IDTF) that submits claims to Novitas, CMS is aware of the need to update their policies to include the HCPCS Beta Amyloid codes. A revision to the policy will be forthcoming to include the CPT Codes A9599 and A9586. After the policy has been updated, IDTFs will need to follow the coverage guidelines in the Local Coverage Determination (LCD): Independent Diagnostic Testing Facility (IDTF) (L35448) as follows:

IDTFs are required to report the exact CPT/HCPCS codes/procedures they intend to perform when enrolling with the CMS-855B form. If an IDTF which is already enrolled wants to perform additional CPT or HCPCS code tests that were not originally specified on its CMS-855B and that are for procedure types and supervision levels similar to its previously allowed codes, the contractor shall have the IDTF amend its CMS-855B to add the additional codes and equipment listing. A new site visit is not required. However, if the enrolled IDTF will be performing CPT or HCPCS codes for different types of procedures, or with different supervision levels, a new site visit is required. Claims submitted with procedure codes not reported on the CMS-855B form and reviewed by the contractor will be denied.

To be clear, after the policy is updated to reflect the codes, please resubmit an 855B application to request the CPT and HCPCS code(s) be added for your site. Until this is completed providers are not approved to bill Medicare for IDEAS patients.

We have also requested that Novitas add two new codes HCPCS codes that will be effective for claims with dates of service on or after July 1, 2016; those codes are noted below for your information. Additional educational materials will be provided by IDEAS. Please note that the two HCPCS codes listed below are not effective until third quarter claim submissions (for dates of service (DOS) on or after July 2016).

Q9983 “Florbetaben f18, diagnostic, per study dose, up to 8.1millicuries ”, effective 7/1/16,

and

Q9982 “Flutemetamol F18, diagnostic, per study dose, up to 5 millicuries”, ,effective 7/1/16

Novitas Solutions – www.novitas-solutions.com
PART A – Jurisdiction L: Delaware, New Jersey, Pennsylvania, Maryland and the District of Columbia;
Jurisdiction H: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas.
PART B – Jurisdiction L: Delaware, New Jersey, Pennsylvania, Maryland and the District of Columbia;
Jurisdiction H: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas.
For Part B services, the A/B MAC Jurisdiction L includes the Counties of Arlington and Fairfax in Virginia and the City of Alexandria in Virginia. Services for the remainder of the state of Virginia are covered under A/B MAC Jurisdiction 11.

The IDEAS Study Operations Team

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