SNMMI Advocates for Improved Reimbursement at CMS Public Meeting

May 21, 2018

SNMMI advocated on behalf of members and their patients at the Centers for Medicare and Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) workgroup public meeting in Baltimore, Maryland, on May 15-16. The society has concerns with the current code descriptors for lutetium-177 (177Lu)-dotatate, gallium-68 (68Ga)-dotatate, and fluorine-18 (18F)-fluciclovine.

Currently CMS lists each of these code descriptors as a per-unit dose for payment, resulting in administrative burden and financial impact to hospitals and medical centers and reducing the availability of these radiopharmaceuticals to those who need them. The society believes that as each of the three radiopharmaceuticals is delivered by pharmacies in per-study doses, CMS should modify the coding descriptors accordingly. SNMMI Committee on Outreach Co-Chair Giuseppe Esposito, MD, MBA, presented the society’s case, as did SNMMI Director of Quality and Evidence Sukhjeet Ahuja, MD, MPH. 

In addition to advocating for members in public meetings, SNMMI provides coding advice on how to bill for each of these radiopharmaceuticals, as well as more than 100 other medical procedures related to nuclear medicine and molecular imaging. For more information, visit the Coding and Reimbursement Q&A webpage.