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CMS Confirms HOPPS Payment Rate Error for CERIANNA™ (Fluoroestradiol F-18) Injection
February 22, 2021
SNMMI has been working with Zionexa to seek proper Medicare reimbursement for Cerianna, radiolabeled 18F-fluoroestradiol indicated for use with positron emission tomography (PET) imaging for detection of estrogen receptor–positive lesions as an adjunct to biopsy in patients with recurrent or metastatic breast cancer. As of January 2021, the HOPPS published rate for this product is incorrect. Recently, the Centers of Medicare and Medicaid Services (CMS) confirmed their error in a HOPPS correction notice. The correct rate is $626.583 per millicurie instead of $0.752 per millicurie.
CMS has told us that any corrections would be retroactive to January 1, 2021. SNMMI will notify our members and update the Q&As when any corrections are implemented. If you are encountering issues with your MAC, please notify SNMMI at hpra@snmmi.org.
As a reminder, for claims with a date of service January 1, 2021, and beyond (for all payers in all settings), please use A9591 Fluoroestradiol F-18, diagnostic, 1 millicurie.