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AdreView™ (Iobenguane 
I 123 Injection) Details

Dosing Information

AdreView dosing is based upon the radioactivity determined using a suitable calibration system immediately prior to administration.

For adults (≥ 16 years of age), the recommended dose is 10 mCi (370 MBq)
For pediatric patients < 16 years of age weighing ≥ 70 kg, the recommended dose is 10 mCi (370 MBq)
For pediatric patients < 16 years of age weighing < 70 kg, the recommended dose should be calculated according to patient body weight

Reimbursement

DISCLAIMER: The information referenced and provided is based on coding experience and research of current general coding practices. The existence of codes does not guarantee coverage or payment for any procedure or contrast agent by any payer. The final decision for coding of any procedure must be made by the provider of care after considering the medical necessity of the services and supplies provided, as well as any regulations and local, state, or federal laws that may apply. The coding and payment data are furnished for general informational purposes only and should not be relied upon for the purposes of determining payer coverage and coding for a specific case or claim for payment. Providers should refer to authoritative coding sources such as the Common Procedural Terminology (CPT®) codes and Healthcare Common Procedure Coding System (HCPCS) codes

Under the Hospital Outpatient Prospective Payment System, Medicare will continue "packaging" for diagnostic radiopharmaceuticals into the payment for the associated procedure.
Diagnostic radiopharmaceuticals are separately payable in physician offices and freestanding imaging centers. Payment is based on 95% of the average wholesale price (AWP) or established by local Medicare contractors (carrier priced).

Physicians performing nuclear medicine procedures using diagnostic radiopharmaceuticals should report the appropriate HCPCS code for the product along with the appropriate CPT® code(s) for the procedure(s). Physicians should make sure the number of units reported is consistent with the quantity of a radiopharmaceutical given to complete the nuclear medicine imaging study.
Some payers may require the National Drug Code (NDC) for Adreview, which is 17156-235-01.
GE HealthCare is pleased to offer toll-free customer support and documentation for coding and reimbursement related to our products. Please contact us at: 800 767 6664
JB09119US July 2024