SNMMI Solves Billing Problem in Much of South

December 15, 2017

Palmetto GBA, a Medicare administrative contractor, has agreed to make billing-policy changes that SNMMI requested regarding payment for wastage from single-dose vials of radiopharmaceuticals. These changes affect North Carolina, South Carolina, Virginia and West Virginia now, and will apply to the states that Palmetto will take over in 2018 (Alabama, Georgia and Tennessee).

In November, SNMMI’s longtime coding consultant, Denise Merlino, MBA, CNMT, FSNMTS, CPC, requested that Palmetto remove a restriction on billing for wastage when a single dose vial is used. On December 14, 2017, Palmetto announced the change and will now allow for billing the wastage with a modifier JW. This decision is retroactive, but claims will have to be refiled.

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