§ 414.38 - Special rules for payment of low osmolar contrast media.

(a) General. Payment for low osmolar contrast media is included in the technical component payment for diagnostic procedures except as specified in paragraph (b) of this section.

(b) Conditions for separate payment. For diagnostic procedures furnished to beneficiaries who are neither inpatients nor outpatients of any hospital, separate payment is made for low osmolar contrast media used in all intrathecal injections and in intravenous, and intra-arterial injections, if it is used for patients with one or more of the following characteristics:

(1) A history of a previous adverse reaction to contrast material, with the exception of a sensation of heat, flushing, or a single episode of nausea or vomiting.

(2) A history of asthma or allergy.

(3) Significant cardiac dysfunction including recent or imminent cardiac decompensation, severe arrhythmias, unstable angina pectoris, recent myocardial infarction, and pulmonary hypertension.

(4) Generalized severe debilitation.

(5) Sickle cell disease.

(c) Method of payment. If one of the conditions of paragraph (b) of this section is met, payment is made for low osmolar contrast media as set forth in § 414.36 as a drug furnished incident to a physician's service, subject to paragraph (d) of this section.

(d) Drug payment reduction. If separate payment is made for low osmolar contrast media, the payment amount calculated in accordance with § 414.36 is reduced by 8 percent to account for the allowance for contrast media already included in the technical component of the diagnostic procedure code.