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Get Reimbursed for Implantable Tissue Markers

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  • In Billing
  • December 14, 2009
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When your physician documents a service involving placement of interstitial devices for radiation therapy guidance, remember to look in the medical chart for any supplies that may have been used. In addition to the procedure code for implanting the device, your physician can also separately report the implantable tissue markers used to perform the service, according to the Centers for Medicare & Medicaid Services (CMS).
Implantable tissue markers are separately billable and payable when used in conjunction with CPT® 55876 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple.
An implantable tissue marker incorporates a contrast agent sealed within a chamber in a container formed from a solid material. The contrast agent is selected to produce a change, such as an increase, in signal intensity under magnetic resonance imaging (MRI). An additional contrast agent may also be sealed within the chamber to provide visibility under another imaging modality, such as computed tomographic (CT) imaging or ultrasound imaging.
Effective Feb. 26, 2010, Medicare will separately reimburse HCPCS Level II code A4648 Tissue marker, implantable, any type, when supplied on the same date as the procedure and reported on the same claim.
This policy, specified in Pub. 100-20 of the Medicare Claims Processing Manual, applies only to physicians paid under the Medicare Physician Fee Schedule (MPFS) payment system. No separate payment for HCPCS Level II A4648 will be made to hospitals, ambulatory surgical centers (ASCs) or other facilities paid under the Inpatient Prospective Payment System (IPPS) or Outpatient Prospective Payment System (OPPS)/ASC payment system.
CMS communicated this one-time notification in Transmittal 604, Change Request (CR) 6579 on Nov. 27.

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