79403 Nuclear therapy Medicare reimbursement rates in Missouri

This service covers therapeutic administration of a radiopharmaceutical for a hematopoietic tumor or marrow disorder. A nuclear medicine physician typically directs the treatment, with administration performed in a hospital or other setting equipped to handle therapeutic radiopharmaceuticals. Phosphorus-32 treatment for selected myeloproliferative diseases is a representative clinical application. The treatment is distinct from radioisotope therapy directed at thyroid disease or delivered into a joint or artery.

Select the code based on the hematopoietic treatment indication, not simply because a radiopharmaceutical was administered. The record should identify the target disease, prescribed radiopharmaceutical, and administration. CMS recognizes professional and technical components: modifier 26 reports the interpretation, modifier TC reports the equipment and staff portion, and an unmodified claim represents the global service. The CMS fee schedule separately prices 26 and TC. The code includes the radiopharmaceutical supply as part of the therapy service; document the administered agent and treatment.