AHA Coding Clinic® for HCPCS - 2002 Issue 2; For your information
Low osmolar contrast media (LOCM) coverage in OPPS
The Centers for Medicare and Medicaid Services (CMS) is expected to soon release a Program Memorandum (PM) with clarification on the coverage of Low Osmolar Contrast Media in a hospital setting. According to CMS, LOCM has always been covered, contrary to past policy statements, regardless of the diagnosis. When LOCM is billed by a hospital, reimbursement will be bundled or packaged into facility payments under the inpatient or outpatient prospective payment systems. The “medical necessity guidelines” for LOCM, found at 42 CFR 414.38(b), clearly apply only to “beneficiaries who are neither inpatients nor outpatients of any...
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Article Overview
This article summarizes CMS guidance about how low osmolar contrast media is treated when furnished in a hospital setting, including how coverage differs by setting and how hospital billing is affected under prospective payment rules. It is aimed at hospital coders, billing staff, compliance teams, and revenue cycle professionals who need to understand CMS policy clarification and related outpatient payment implications.
Why This Topic Matters
The guidance affects whether charges are treated as separately payable or packaged in hospital claims, and it highlights setting-specific differences that can affect patient liability, claim reporting, and hospital billing workflow.
What You Will Learn
- How CMS describes coverage of low osmolar contrast media in a hospital setting
- How payment treatment is discussed under inpatient and outpatient prospective payment systems
- How coverage differs between hospital and physician office settings
- What the article says about hospital claim reporting and outpatient billing considerations
Who Should Read This
- Hospital coders
- Outpatient hospital billing staff
- Compliance professionals
- Revenue cycle staff
- Healthcare reimbursement analysts
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