Results 1 to 2 of 2

A Codes - familiar with billing

  1. #1
    Long Island/New York
    Default A Codes - familiar with billing
    Clearnace Sale
    is anyone familiar with billing out a9555 and a9552 pharm codes? i need a little help (i.e. units i can bill for specific cardiology procedures)?

  2. #2

    I hope you have room for a bucket of headaches.

    A9555 is Rubidium-82 and is used in conjunction with PET myocardial perfusion studies [78491 and 78492]. A9552 is commonly called FDG [fluorodeoxyglucose F18] and is used in conjunction with PET cardiac metabolic studies [78459].

    For Medicare, coverage, pricing and coding policy is left to the MACs. In general, the MACs require that you report a "per study" dose at your exact invoice cost and may require claims to be accompanied by an invoice.

    Rubidium-82 does not come in vials, bottles or other containers. Rb-82 is produced by a generator. The rubidium is generated at the time of the study and is infused directly into the patient. There is usually a "dose" generated at rest and a "dose" generated at stress. Each dose is measured in millicuries [mCi] which are added together to determine the number of mCi used for the study. [This is going to get complicated].

    Invoice costs are a challenge. Our practice pays a monthly rental for the rubidium generator. At the end of the month, we total the number of "per study" doses used and divide that into the monthly rental cost to determine our "invoice" cost for a per study dose. Obviously, it will vary somewhat from month to month. [More on this below].

    Using more than 60 mCi per study becomes an issue. Up to 60 mCi is reported on claims as 1 unit with an invoice cost equal to the monthly per study calculation. If > 60 mCi are used during a study, 2 units should be reported, but this hits against an medically unlikely edit [MUE] which is apparently set at 1 for A9555. [CMS started publishing MUEs on 10/1/2008, but I haven't looked at them yet]. Your practice will have to decide how to handle this issue.

    Under our previous Medicare carrier [Pinnacle] we delayed billing A9555s until the end of the month when our exact invoice costs were determined. During the month, we reported the PET study and after the end of the month, we filed claims for A9555. Our current MAC [TrailBlazer] established a per study allowable for A9555. They will pay the lesser of the allowed amount or our invoice costs. So far, our invoice costs are above the allowable, so we are able to report A9555 with the claim for the PET study. If our invoice costs fall below the allowable [or we suspect that they will], we will have to revert to the previous billing method so that we stay in compliance.

    There are also issues with FDG.

    There are more considerations when dealing with Medicare Advantage plans and commercial payers.

    This is a bit long. For more, contact me direct at

    Terry Davis

Similar Threads

  1. Replies: 4
    Last Post: 01-30-2015, 12:36 PM
  2. Reimbursement for consult codes vs medicare new office/hospital eval codes
    By cardiocoder in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-20-2014, 08:09 PM
  3. REV codes which now require HCPC/CPT codes
    By Temeka in forum Medicare Regulations
    Replies: 1
    Last Post: 02-15-2011, 09:39 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.