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Coding and Reimbursement

• Congress passes 2023 Consolidated Appropriations Act

  Dec 29, 2022 — On December 23, 2022, the U.S. House of Representatives passed H.R. 2617, the 2023 Consolidated Appropriations Act (also referred to as the Omnibus package) by a vote of 225-201-1.

• CMS Publishes 2023 MPFS and Hospital OPPS Final Rule

  Nov 22, 2022 — On November 1, CMS released the 2023 Medicare Physician Fee Schedule and Hospital Outpatient Prospective payment Final Rules.

• The U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury released final rules titled “Requirements Related to Surprise Billing: Final Rules.”

  Sep 13, 2022 — The U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury released final rules titled “Requirements Related to Surprise Billing: Final Rules.” Read more for highlights of the updated rules.

• SNMMI Urges Congress to Avert Cuts to Physician Reimbursement

  Aug 4, 2022 — Recently SNMMI—with more than 100 medical societies and various industry groups—espoused its support in two letters for averting cuts to the Medicare Physician Fee Schedule (MPFS) Proposed Rule.

• CMS releases its CY 2023 Medicare Physician Fee Schedule Proposed Rule

  Jul 14, 2022 — The Centers for Medicare and Medicaid Services (CMS) released its 2023 Medicare Physician Fee Schedule (MPFS) Proposed Rule on July 7.

• Aetna Reverses Cardiac PET/CT Non-Coverage & Updates Policy for PSMA Therapy

  Jun 27, 2022 — SNMMI and ASNC requested that Aetna reverse its non-coverage cardiac PET/CT policy. We are thrilled to communicate that within a few days of receiving our letter, Aetna reversed the policy. Also, Aetna recently updated and published their coverage policy for PSMA imaging for PLUVICTO therapy eligibility.

• SNMMI and Partners Request a Hearing for the FIND Act

  Apr 28, 2022 — This week, SNMMI and over 70 organizations sent a letter to House Energy and Commerce and Ways and Means Committee Leadership requesting a hearing on the Facilitating Innovative Nuclear Diagnostics (FIND) Act.

• SNMMI Hosts AI and Patient Access Summits

  Mar 28, 2022 — On March 21-23, SNMMI hosted two summits in Bethesda, MD, on Artificial Intelligence and Barriers to Patient Access. The aim of the summits—the first of their kind for the society—was to bring together thought leaders to discuss current obstacles in the field of nuclear medicine and provide solutions. Read the highlights.

• SNMMI Congratulates FDA Commissioner Califf

  Feb 18, 2022 — SNMMI congratulates Robert Califf, MD, on his confirmation as the 25th Commissioner of the U.S. Food and Drug Administration.

• SNMMI Advocates for Expanded Coverage & Reimbursement of Amyloid PET

  Feb 17, 2022 — When CMS issued a national coverage determination analysis for Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease, SNMMI took action.

• SNMMI Supports Intent of No Surprises Act, Issues Further Recommendations

  Dec 23, 2021 — SNMMI strongly supports the goals of the No Surprises Act—including protecting patients from surprise medical bills, improving the availability of affordable, high-quality, in-network care, and developing a fair and impartial process for resolving provider-insurer payment disputes—and recommends that the government make specific clarifications to the interim final rules.

• Senate Passes Protecting Medicare and American Farmers from Sequester Cuts Act

  Dec 10, 2021 — Last night, SNMMI and more than 300 medical societies rejoiced when the Senate passed the Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610).

• With a New Bill, SNMMI Urges Congress to Avert Cuts to Physician Reimbursement

  Dec 1, 2021 — Once again, SNMMI and more than 300 medical societies voiced their support for averting the looming cuts to the Medicare Physician Fee Schedule (MPFS). Following the release of the Calendar Year 2022 MPFS Rule that indicated the Centers for Medicare and Medicaid Services (CMS) will allow this payment adjustment to expire at the end of 2021, Reps. Bera, MD and Bucshon, MD introduced H.R. 6020. Their bipartisan legislation would extend the 3.75% update to the conversion factor for an additional year.

• CMS Grants Transitional Pass-Through Payment Status for PSMA PET Imaging Agent for Prostate Cancer

  Nov 24, 2021 — On November 22, CMS granted transitional pass-through payment status for 18F-piflufolastat, increasing patient access to an innovative imaging approach for detecting the spread of prostate cancer to other parts of the body.

• SNMMI Lauds CMS Decision to Expand Coverage for Non-Oncologic PET

  Nov 11, 2021 — SNMMI lauds last week’s decision by CMS to remove exclusionary language relating to the non-oncologic use of PET, expanding access to critical care for patients.

• CMS Publishes MPFS and OPPS Final Rules Expanding Coverage for Non-Oncologic PET

  Nov 9, 2021 — Last week, the Centers for Medicare and Medicaid Services (CMS) finalized its Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective System (OPPS) rules.

• The FIND Act Gets a Senate Companion Bill

  Sep 26, 2021 — On August 4, 2021, Senators Marsha Blackburn (R-TN) and Tammy Baldwin (D-WI) introduced the Facilitating Innovative Nuclear Diagnostics (FIND) Act of 2021 (S. 2609), legislation that would significantly expand patient access to advanced nuclear diagnostic imaging technologies.

• CMS Revokes Coding Barriers for 18F FDG PET Infection and Inflammation NCD Retirement

  Aug 3, 2021 — In December 2020, CMS retired the National Coverage Determination for F-18 FDG PET for infection and inflammation, effective January 1, 2021. On June 8, CMS put forth certain ICD-10 codes for osteomyelitis and fever of unknown origin in a transmittal—which they would NOT cover. Yesterday, that decision was reversed.

• SNMMI and Coalition Partners Applaud the Introduction of the FIND Act

  Jul 21, 2021 — On July 16, Congressmen Scott Peters (D-CA), Bobby Rush (D-IL), Neal Dunn (R-FL) and Greg Murphy (R-NC) introduced the Facilitating Innovative Nuclear Diagnostics (FIND) Act of 2021 (H.R. 4479), legislation that would significantly expand patient access to advanced nuclear diagnostic imaging technologies.

• SNMMI Authors Member Template Letter for SPECT/CT Coverage Denials

  Jun 3, 2021 — After many complaints from our members about SPECT/CT coverage denials from various commercial payers, SNMMI has put forth a resource members can use to contest these decisions.

• CMS Confirms HOPPS Payment Rate Error for CERIANNA™ (Fluoroestradiol F-18) Injection

  Feb 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.

• Courtney Lawhn-Heath Awarded 2019 Henkin Fellowship

  Apr 23, 2019 — SNMMI is pleased to announce that Courtney Lawhn-Heath, MD, has been selected as the recipient of the 2019 Robert E. Henkin Government Relations Fellowship.

• Aria Razmaria, MD, Awarded 2018 Henkin Fellowship

  Apr 11, 2018 — SNMMI and the Education and Research Foundation for Nuclear Medicine and Molecular Imaging are pleased to announce that Aria Razmaria, MD, has been selected as the recipient of the 2018 Robert E. Henkin Government Relations Fellowship.

• FDA Issues Draft Guidances on Compounding and Repackaging Radiopharmaceuticals

  Jan 11, 2017 — The FDA issued two draft guidances that describe FDA’s proposed policies regarding the compounding and repackaging of radiopharmaceuticals for human use by state-licensed nuclear pharmacies or federal facilities, and outsourcing facilities.

• SNMMI Develops USP Recommendations for Compounded Sterile Radiopharmaceuticals

  Dec 14, 2016 — SNMMI has developed USP Recommendations for Compounded Sterile Radiopharmaceuticals.

• House Passes 21st Century Cures Bicameral Compromise

  Dec 1, 2016 — On Wednesday, November 30, the House passed the 21st Century Cures legislation 392-26, sending the sweeping FDA and CMS reform package to the Senate.

• A Look at the New Administration’s Healthcare Nominees

  Nov 29, 2016 — President-elect Donald Trump’s healthcare nominees are in keeping with his promise to repeal and replace the Affordable Care Act (ACA), as well as to work with Republicans to overhaul Medicare and Medicaid significantly. Trump has selected Republican Representative Tom Price, an orthopedic surgeon from Georgia, to lead the Department of Health and Human Services and Seema Verma—president, CEO and founder of SVC, Inc., a national health policy consulting company—to serve as CMS administrator.

• CMS Releases CY 2017 HOPPS & MPFS Final Rules - Effective January 1, 2017

  Nov 3, 2016 — CMS released the CY 2017 Final Rules for the Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Physician Fee Schedule.