Does Medicare reimbursement cover the cost of the SIR-Spheres microspheres?
The cost of the SIR-Spheres microspheres is reimbursed under C2616. Payment is made in addition to the APC(s) associated with the infusion of the SIR-Spheres microspheres. Payment for the SIR-Spheres microspheres is hospital specific therefore hospitals will receive different payment amounts. Payment is based on each hospital’s cost-to-charge ratio, reduced to cost, using their historical cost-to-charge ratio. Depending on the hospital’s mark-up (charge) on the SIR-Spheres microspheres, most hospitals should recover the cost of the device in addition to the associated procedures. The financial department of the hospital is familiar with their cost-to-charge calculations and should be consulted for additional clarification.
