Get Paid Separately for Tissue Markers, Dosimeters

Effective Nov. 6, physicians separately can report implantable tissue markers (HCPCS Level II A4648 Tissue marker, implantable, any type, each) and implantable radiation dosimeters (A4650 Implantable radiation dosimeter, each) in Medicare Part B claims.

To receive payment for these miscellaneous supplies, codes A4648 and A4650 must be billed in conjunction with one of the following CPT® codes:

19499 Unlisted procedure, breast

32553 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous intra-thoracic, single or multiple

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

55876 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple

If one of the above CPT® codes is not paid on the same claim (or in history) with the same date of service, payment will be denied.

No policy change has been made for hospitals paid under the Outpatient Prospective Payment System (OPPS), Inpatient Prospective Payment System (IPPS), or ambulatory surgical centers (ASCs) paid under the ASC Payment System. Current Medicare policy continues to instruct Medicare contractors not to separately reimburse claims for HCPCS Level II codes A4648 or A4650 to hospitals and ASCs paid under these payment systems.

Refer to the Centers for Medicare & Medicaid Services (CMS) Transmittal 745, Change Request (CR) 6968, issued Aug. 6, for further clarification of this physician payment policy in Pub. 100-20 of the Medicare Claims Processing Manual.

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