Quarterly Coding and Billing Reference Sheets for Lexiscan
Appropriate and accurate coding is important for healthcare providers to receive proper reimbursement for drug therapies like Lexiscan. Coding should reflect services provided to the patient as documented in the patient's medical record. Medicare uses the Medicare Physician Fee Schedule (MPFS) to pay physicians for drugs and services provided to patients. Medicare adjusts the payments based on the geographic location of the physician. For specific payment levels in your area, go www.cms.gov/apps/physician-fee-schedule/.
Medicare bases payment for hospital outpatient facilities on Ambulatory Payment Classifications (APCs). Procedures that share similar clinical characteristics and are similar in terms of cost requirements are grouped together into an APC. Medicare assigns each APC group a payment amount that is made to the hospital.
- Second Quarter 2012 (4/1/12 - 6/30/12) (PDF - 315 KB)
- First Quarter 2012 (3/1/12 - 3/31/12) (PDF - 315 KB)
IMPORTANT INFORMATION: The coding, coverage, and payment information contained herein is gathered from various resources, general in nature, and subject to change without notice. Third-party payment for medical products and services is affected by numerous factors. It is always the provider's responsibility to determine the appropriate healthcare setting and to submit true and correct claims for those products and services rendered. Providers should contact third-party payers for specific information on their coding, coverage, and payment policies. Information and materials provided by ARS are to assist healthcare providers, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the provider. Information provided should in no way be considered a guarantee of coverage or reimbursement for any product or service.
