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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