The Codes You Must Use When Billing for 99mTc-PYP
for the Evaluation of Cardiac ATTR Amyloidosis
As the paradigm for testing and treatment of cardiac amyloidosis continues to shift, ASNC receives questions from members seeking guidance on proper billing practices for 99mTechnetium-pyrophosphate imaging for cardiac transthyretin amyloidosis. Here are answers to common questions:
What are ASNC’s recommendations for billing 99mTechnetium-pyrophosphate imaging for cardiac transthyretin amyloidosis?
When you perform planar imaging with SPECT, you should use CPT code 78803 – radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); tomographic (SPECT). Under the CY2022 Medicare Physician Fee Schedule, CPT code 78803 is reimbursed at a rate of $375.83 for services performed in a physician's office.
When reporting CPT code 78803, planar imaging of a limited area or multiple areas should be included with the SPECT.
For the HCPCS level II code, report A9538 – 99mTc-pyrophosphate, diagnostic, per study dose, up to 25 millicures, to describe the radiopharmaceutical used.
If you perform a single planar imaging session alone (without a SPECT study), you should report CPT code 78800.
Why is proper billing and coding important for cardiac amyloidosis programs?
Proper billing and coding are essential for all medical services, including for cardiac amyloidosis, to ensure accurate reimbursement for physician-provided services. As the Centers for Medicare & Medicaid Services (CMS) emphasizes, proper billing and coding prevent improper payments and protect the Medicare Trust Fund. This is why CMS oversees the medical review program,
which identifies errors through claims analysis. Medical reviews are conducted by Medicare Administrative Contractors (MACs), supplemental medical review contractors (SMRCs) and Recovery Audit Contractors (RACs).
Where should imagers and their teams go for guidance on cardiac amyloidosis program development and imaging protocols?
ASNC is your best resource for education and information on cardiac amyloidosis. The March 11-13
virtual program "Nuclear Cardiology NOW: Strategies for Optimization, Efficiency and Productivity"
will feature a three-hour intensive titled "Cardiac Amyloidosis: Best Practices to Optimize Patient Care and Your Practice."
We recommend attending Nuclear Cardiology NOW
to learn best practices for setting up a new cardiac amyloidosis program; issues to discuss with your team before you begin seeing patients;
and how to ensure referrals, remove barriers, anticipate challenges, and deliver reports your referring colleagues will find valuable. REGISTER NOW.
ASNC members also have access to Practice Points
TC-PYP and DPD imaging for cardiac amyloidosis. These handy fact sheets summarize key takeaways from clinical publications, making them invaluable if you are launching a cardiac amyloidosis program. DOWNLOAD NOW.