Radiopharmaceuticals

Radiopharmaceuticals A. The Division of Medicaid covers radiopharmaceuticals administered for diagnostic or therapeutic purposes separately from the diagnostic procedure or visit. 1. Only the units administered are covered. 2. Radiopharmaceuticals must be approved by the (FDA), used in accordance with FDA approved conditions, and be administered in dosages that meet FDA regulations. 3. Radiopharmaceuticals considered experimental, investigative, or in clinical trial are not covered. A. The Division of Medicaid covers radiopharmaceuticals administered in a physician office, clinic or independent radiology facility. C. Radiopharmaceuticals administered in an outpatient hospital setting is reimbursed in accordance with the Division of Medicaid’s outpatient hospital methodology.