CMS’ new reimbursement rate for FDG PET of $1375.00 has both good and disappointing news for those interested in bringing Positron Emission Tomography (PET) to the broadest number of patients, according to the Society of Nuclear Medicine (SNM) and the American College of Nuclear Physicians (ACNP).
SNM and ACNP believe that this lower rate (down from the previous $2,331.18) may have a negative impact on the expansion of PET services into communities where it does not currently exist, since it will be more difficult for hospitals and other facilities to recoup the significant costs associated with the installation and operation of PET centers. This is unfortunate, since PET is increasingly used in clinical medicine, and is a vital diagnostic and treatment planning tool for many cancers, neurological and cardiac conditions.
On the positive side, SNM and ACNP are pleased at CMS’s responsiveness to the concerns expressed when proposed reduced reimbursement amounts were first posted in August. This was particularly significant as it relates to the cost of the 18-flurodeoxyglocose (FDG) injected as part of the PET scan process. CMS originally proposed an FDG PET reimbursement of $841.50, when the published average wholesale price (AWP) for FDG is $750. Facilities would lose money with each scan.
“This process demonstrated that the medical profession and the government can work together,” stated Alan Maurer, M.D., President of the SNM. “We were able to show how there were errors in the data on which CMS had originally based its proposed reimbursement, and the agency responded by developing a more reasonable, though still disappointing, reimbursement amount.
“Because CMS relies on data to make its reimbursement decisions, this effort also demonstrates how important it is for those of us in the PET field to be particularly precise when we code and submit claims to the agency. We look forward to working with CMS in the future on this, and to expanding the approved PET indications to include areas for which PET is an effective tool, but not currently reimbursed by Medicare.”
Dr. Maurer recently created a new government relations subcommittee chaired by Peter Conti, M.D. The subcommittee is tasked with working to extend PET coverage to new indications and improving the overall reimbursement for PET procedures. The subcommittee is examining the impact of the new FDG reimbursement rate on the nuclear medicine community.
The Society of Nuclear Medicine is an international scientific and professional organization of more than 13,000 members dedicated to promoting the science, technology, and practical application of nuclear medicine. The American College of Nuclear Physicians represents the socio-economic interests of the nuclear medicine community. SNM and ACNP are based in Reston, Virginia. For more information, visit http://www.snm.org