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Msg  32918 of 33103  at  9/27/2020 3:07:26 PM  by

FIRAC

The following message was updated on 9/27/2020 10:56:49 PM.

 In response to msg 32914 by  z3peru
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Re: Royalties edit at end

     z3peru: ...could not find info on [Lymphoseek] price...
 
I have found prices at Calif. hospitals that are required to post procedure prices online, but it is rather tedious since you have to go to each hospital website individually.  There is a 3x difference in prices if you shop around.  I have also found this 2020 Medicare Payment Chart incl Lymphoseek
Go to page 4 of this chart and look for HCPCS/CPT codes 78800 and 78803 which are prices for APC codes 5591 and 5592 (now 5593)
 
The Medicare reimbursement for 
"Radiopharamaceutical localization of tumor or distribution of radiopharamceutical agent(s): limited area" went from $353.49 in 2019 to $368.08 in 2020, and reimbursement for 

"Radiopharamaceutical localization of tumor or distribution of radiopharamceutical agent(s): tomographic (SPECT)" went from $455.52 in 2019 to a whopping $1272.05 in 2020 (a 64.2% increase).

BTW, these numbers are close but not exactly the same as Medicare payments found on the CAH website ($368.13 and $471.98 respectively).  [Download "Coding, coverage and payment for LYMPHOSEEK imaging"]

edit:  note the price a hospital charges and the price Medicare reimburses a hospital does not really answer z3peru's initial question of how much CAH charges per dose.  Royalties are based on what CAH charges.
Also,  I found another Radiopharmaceutical Fee Schedule with no change in   2019          2020 prices

A9520

Technetium Tc 99m tilmanocept, diagnostic

$535.57

$535.57 

 edit 2:  I now see that Medicare has the country divided into several jurisdictions and prices for the same drug or procedure varies depending on locality.  For instance the $535.57 price for Lymphoseek only applies in Jurisdiction F which is AL, AZ, ID,MT, ND,OR, SD,UT, WA, WY.
 
 
 


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