Contrast Media

Billing and Reimbursement
Policy Number: RP-P-014

Last Updated: Feb. 7, 2022 

Low and High Osmolar Contrast Agents

Low- and high-osmolar agents are used with the appropriate range of CPT codes.       

Low-osmolar agents (e.g., Isovue) are used primarily in patients with sensitivities to the high-osmolar agents (e.g., Hypaque) or patients whose medical condition (e.g., cardiac disease, asthma) warrants the use of the low-osmolar agent. Blue Cross and Blue Shield of Nebraska currently recognizes and allows benefits for the low-osmolar agents.       

High-osmolar agents are already calculated into the RVU and reimbursement rate for each code. The cost of these agents is content to the procedure. Therefore, charges for high-osmolar agents cannot be billed separately.

Radiopharmaceutical Agents

Radiopharmaceutical agents must be billed with the appropriate range of CPT codes. When billing for a radiopharmaceutical agent, providers must be as specific as possible with coding, or the claim will be returned. Include the name of the radiopharmaceutical used and bill under the appropriate code in the HCPC Level II Code book.    

Do not use unlisted codes, as they do not identify the specific agent used.  

Some agents have medical policies tied to them and others may be affected by a policy in the future. The introduction of a needle or intracatheter vein used as the delivery mode for the radiopharmaceutical contrast agent is incidental and will be denied.