Action Alerts

Packaged Services in 2008
Reporting Diagnostic Radiopharmaceuticals on a Medicare Outpatient
January 2008

Diagnostic radiopharmaceuticals are one category that CMS "packaged" when billing services for a Medicare outpatient in CY 2008. This means that CMS will not pay separately for these 52 radiopharmaceuticals when listed on the claim. Diagnostic radiopharmaceuticals are reported with revenue code 343.

Radiopharmaceuticals are considered either diagnostic or therapeutic. While all diagnostic radiopharmaceuticals are packaged, therapeutic radiopharmaceuticals are not.

In addition, effective January 1, 2008, CMS has implemented an edit (78) in the outpatient code editor (OCE) for services furnished after January 1, 2008. Claims will be returned to the provider (RTP'd) when a nuclear medicine study has been billed but a diagnostic radiopharmaceutical has not been listed on the outpatient claim.

It is recommended that your hospital’s charge description master is reviewed to be sure that all radiopharmaceuticals are billed on the claim and listed with the appropriate revenue code for diagnostic (revenue code 343) or therapeutic (revenue code 344).