November 3, 2017
The Centers for Medicare and Medicaid Services (CMS) has released a total of 4,036 pages in the Federal Register describing changes for Medicare in 2018. This is a preliminary summary of rules affecting nuclear medicine and molecular imaging. There are some new tweaks for this specialty, but no major surprises or changes.
Three rules were released. They are the Physician Fee Schedule (PFS) rule, the Hospital Outpatient Prospective Payment System (OPPS) rule and the Quality Payment Program (QPP) rule. The rules all take effect on January 1, 2018.
Physician Fee Schedule
In the PFS rule, CMS estimates that payments to nuclear medicine physicians (and most physicians) will see a 0.3 percent increase in payments in 2018. The mandate that referring physician consult Appropriate Use Criteria (AUCs) is pushed back from 2018 to 2020.
For individual rates, see the SNMMI detailed chart.
Hospital Outpatient Prospective Payment Rule
The OPPS rule includes an overall 1.4 percent payment increase for 2018. CMS again rejected our recommendations to create separate ambulatory patient classifications (APCs) for high value radiopharmaceuticals.
All nuclear medicine procedure rates have positive increases in payments for CY 2018, some modest and others larger. For individual rates, see the SNMMI detailed chart.
The HCPCS committee did not agree to create new “per study dose” codes for gallium-68-DOTATATE or Fluciciovine, as those remain per 0.1 millicurie or per 1 millicurie. Therefore, there are no changes to how you report those products.
We have also prepared a high-level PowerPoint of the nuclear medicine APC rates for procedures: http://www.snmmi.org/IssuesAdvocacy/content.aspx?ItemNumber=1791&navItemNumber=572
The Quality Payment Program
On the QPP front, CMS described changes in the second transition year for the Merit-Based Incentives Payment System (MIPS) and for Advanced Alternative Payment Models (APMs).
They surprisingly decided to start measuring the costs of physicians as 10 percent of a physicians’ Merit-Based Incentive Payment System (MIPS) score. The cost measurement system is widely considered to be rudimentary at best. Based on 2018 performance, clinicians and groups will be eligible to receive a payment bonus or penalty of up to 5 percent in 2020 under MIPS.
For More Information
Links to the rules and CMS summaries of these rules are available below: