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Coding and Reimbursement

• SNMMI Urges Congress to Avert Cuts to Physician Reimbursement

  Oct 15, 2021 — Yesterday, SNMMI and more than 200 other medical societies espoused their support for averting cuts to the Medicare Physician Fee Schedule (MPFS). Reps. Bera (D-CA) and Buschon (R-IN) led this effort in the following "Dear Colleague" letter to House leadership, supported by 245 members of Congress.

• 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.

• CMS Announcements Hold Big Surprises for PET Scans

  Jul 19, 2021 — Last week brought two big announcements from CMS: a national coverage analysis notice on Alzheimer's disease treatment and the Medicare Physician Fee Schedule (MPFS).

• Update: Humana Reverses Non-Oncologic PET/CT Non-Coverage Policy

  Jun 21, 2021 — Months ago, Humana reversed its decision to deny coverage for PET/CT imaging of gastric and esophageal oncologic indications. Now we have more good news.

• NCCI Implements More of SNMMI's Proposed Changes to PTP Edits

  Jun 8, 2021 — On June 1, CMS's National Correct Coding Initiative posted several Procedure to Procedure edit corrections requested by SNMMI for several of the new and revised CPT codes.

• 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.

• NGS Agrees with SNMMI & Partners on PET/CT Reimbursement Changes

  May 18, 2021 — Earlier this week, SNMMI and our partners, ACR, ASNC, and ACC, heard good news from National Government Services medical director Stephen A. Boren, MD.

• SNMMI & Partners Urge Congress to Expand MPFS Relief into 2022

  Apr 28, 2021 — This week SNMMI and 62 organizations, representing more than one million healthcare providers, thanked Congress for past efforts on physician reimbursement and requested the inclusion of provisions to future legislation.

• A Partial Win: Humana Reverses PET/CT Non-Coverage Policy

  Apr 27, 2021 — Since November 2020, SNMMI has been in communications with Humana regarding its decision to deny coverage for PET/CT and SPECT/CT. Now the company has partially reversed its decision.

• Medicare Sequester Moratorium Is Officially Extended

  Apr 15, 2021 — Yesterday, President Biden signed legislation extending the moratorium on Medicare sequestration. This occurred after the House passed the Medicare Sequester Relief Act late Tuesday, which extended mandated 2% Medicare cuts to healthcare providers until the end of the year.

• Reps. Peters and Rush Urge CMS for an OPPS Regulatory Fix

  Apr 12, 2021 — Last week, Reps. Scott Peters (D-CA 52nd District) and Bobby Rush (D-IL 1st District) sent a letter to the Centers of Medicare and Medicaid (CMS) Acting Administrator Elizabeth Ritcher. The letter addressed their concerns regarding the current reimbursement methodology associated with diagnostic radiopharmaceuticals under the Medicare Hospital Outpatient Prospective Payment System (OPPS).

• SNMMI & Partners Advocate for Extension of Medicare Sequester Moratorium

  Mar 22, 2021 — Last week, SNMMI and its partners strongly urged Congress to pass H.R. 1868 to extend Medicare sequester moratorium through the end of 2021.

• MAC Update on Retirement of NCD for FDG PET Infection & Inflammation

  Mar 11, 2021 — Subsequent to the retirement by CMS of the NCD for the non-coverage of FDG PET for infection and inflammation, in the absence of a MAC Local Coverage Determination, National Coverage Determination, or CMS Manual Instruction, reasonable and necessary guidelines apply.

• NCCI Implements Some of SNMMI's Proposed Changes to PTP Edits

  Mar 4, 2021 — On March 1, 2021, CMS' National Correct Coding Initiative (NCCI) implemented several Procedure to Procedure (PTP) edits proposed by SNMMI for several of the new and revised CPT codes. These edits are retroactively effective January 1, 2020.

• SNMMI & Coalition Partners Gather to Discuss the Importance of Providing Access to Advanced Nuclear Imaging Procedures

  Mar 3, 2021 — SNMMI, with MITA and CORAR, hosted a virtual briefing with physicians, patients, and industry representatives. Discussions centered on the need to provide patient access to innovative nuclear diagnostics and the growing role of PET, SPECT, and nuclear medicine in detecting life-threatening diseases.

• CMS Retires National Non-Coverage Policy for FDG PET Infection and Inflammation

  Mar 1, 2021 — Since 2008, CMS has not covered PET for imaging of infection and inflammation. Now that has changed.

• SNMMI & Partners Urge Congress to Waive Budget Neutrality for MPFS Beyond 2021

  Feb 23, 2021 — SNMMI and 74 other organizations urged legislators to consider additional policy options in the year ahead to address shortcomings in physician reimbursement.

• 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.

• Detectnet™ (Copper Cu-64 Dotatate Injection) Gets a New HCPCS Level II Code

  Feb 10, 2021 — Recently, the Centers of Medicare and Medicare and Medicaid Services (CMS) granted Detectnet™ a HCPCS Level II Code, A9592 (copper cu-64, dotatate, diagnostic, 1 millicurie), effective April 1, 2021.

• President Signs 2021 Appropriations Act, Supplements Physician Reimbursement, Provides COVID-19 Relief

  Dec 27, 2020 — Today, President Trump signed the Coronavirus Response and Relief Supplemental Consolidated Appropriations Act of 2021 into law. The House (359 to 53) and Senate (91 to 7) passed the legislation by a vote of 359 to 53 on December 22. This is good news for physician reimbursement.

• SNMMI and Coalition Support Bill Waiving Budget Neutrality in New Senate Bill

  Dec 15, 2020 — Yesterday, SNMMI and a coalition consisting of 77 medical societies sent a letter to Congress in support of S. 5007, a bill to halt pending Medicare payment cuts resulting from the planned evaluation and management (E/M) code changes slated for implementation on January 1, 2021.

• Final 2021 MPFS Rule Fails to Provide Relief, SNMMI and Coalition Lobby Congress to Protect Physician Reimbursement and Access to Care

  Dec 2, 2020 — Yesterday evening, December 1, the Centers for Medicare and Medicaid Services (CMS) released the calendar year 2021 Medicare Physician Fee Schedule (MPFS) final rule. Though SNMMI agrees with the adoption of the new evaluation and management (E/M) coding structure recommended by the American Medical Association (AMA), this will result in significant payment reductions to nuclear medicine (~8%) and radiology (~11%) services unless the government removes the budget neutrality requirements.

• SNMMI Objects to Humana’s Decision to Deny Coverage for PET/CT & SPECT/CT

  Nov 12, 2020 — On November 6, SNMMI received word regarding Humana’s recent decision [Policy Number: HCS-0506-010] to deny coverage for PET/CT (CPT codes 78429-78433) and SPECT/CT (78830, 78832) on the basis that it is “experimental/investigational” and “not identified as widely used and generally accepted for the proposed uses as reported in nationally recognized peer-reviewed medical literature.”

• SNMMI and Coalition Support Bill Waiving Budget Neutrality, Increasing Proposed Physician Reimbursement for 2021

  Nov 11, 2020 — Today, SNMMI and a coalition consisting of 73 medical societies sent a letter to Congress in support of H.R. 8702, a bill to halt pending Medicare payment cuts resulting from the planned evaluation and management (E/M) code changes slated for implementation on January 1, 2021.

• SNMMI and Partners Ask Congress to Waive Budget Neutrality for MPFS

  Oct 13, 2020 — On Friday, SNMMI and several medical societies sent a joint letter asking Congress to waive budget neutrality for the relative value unit increases in the CY 2021 Medicare Physician Fee Schedule. The CMS Proposed CY 2021 MPFS Rule increased payment rates for evaluation and management codes; however, because of budget neutrality imposed by Congress, increases would lead to huge deficits other payment rates.

• SNMMI Comments on 2021 MPFS Proposed Rule

  Sep 30, 2020 — On Monday, August 3, the Centers for Medicare and Medicaid Services (CMS) released the calendar year 2021 Medicare Physician Fee Schedule (MPFS) proposed rule. Though SNMMI agrees with the adoption of the new evaluation and management (E/M) coding structure recommended by the American Medical Association (AMA), this will result in significant payment reductions to nuclear medicine (~8%) and radiology (~11%) services unless the government removes the budget neutrality requirements.

• SNMMI and Partners Host Congressional Briefing on the Groundbreaking Potential of Radiopharmaceuticals in Oncology and Need for Expanded Patient Access

  Sep 17, 2020 — Yesterday, SNMMI and its coalition partners, Medical Imaging & Technology Alliance (MITA) and Council on Radionuclides and Radiopharmaceuticals, Inc. (CORAR) hosted a virtual briefing for Capitol Hill staff yesterday with leading physicians to discuss the extraordinary and growing impact of positron emission tomography (PET) and nuclear medicine in cancer treatment, as well as the importance of expanding patient access to these drugs through passage of the Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019 (H.R. 3772).

• CMS extends the AUC Program Educational and Operations Testing Period through CY 2021

  Aug 11, 2020 — The Centers for Medicare and Medicaid Services (CMS) has provided an update regarding the Appropriate Use Criteria (AUC) Program established by The Protecting Access to Medicare Act (PAMA) of 2014.

• CMS Releases 2021 MPFS Proposed Rule

  Aug 4, 2020 — On August 3, CMS released the 2021 Medicare Physician Fee Schedule proposed rule. In this rule, CMS proposed changes to the payment provisions, introduced new coding structure for the evaluation and management codes and updated the Quality Payment Program.

• Recent HHS Updates During the COVID-19 Pandemic

  May 19, 2020 — As we wait the enactment of a fourth stimulus package, SNMMI would like to inform its membership of the recent U.S. Department of Health and Human Services (HHS) administrative updates as a result of COVID-19.

• SNMMI Advocates for Access to Diagnostic Radiopharmaceuticals through COVID-19 and Beyond

  May 15, 2020 — This week SNMMI and its coalition partners sent a letter imploring Congress to take immediate action to ensure patient access to FDA-approved diagnostic radiopharmaceutical drugs that aid in the detection of cancer, cardiovascular conditions and neurological disorders.

• Congressman Greg Murphy, MD, Signs On to the Medicare Diagnostic Radiopharmaceutical Payment Equity Act

  Apr 16, 2020 — Last week, SNMMI had the chance to sit down and talk with Congressman Greg Murphy, MD, a urologist representing North Carolina’s 3rd Congressional district. Congressman Murphy is the first physician to sign on to HR 3772, the Medicare Diagnostic Radiopharmaceutical Payment Equity Act.

• NCCI Agrees with SNMMI's Proposed Changes to Edits PTP Errors

  Mar 5, 2020 — Due to SNMMI's diligence, CMS' National Correct Coding Initiative (NCCI) confirmed that its proposed Procedure to Procedure (PTP) edits for several of the new and revised CPT codes (effective January 1, 2020) will be corrected.

• NCCI Agrees with SNMMI's Proposed Changes to PTP Edits

  Mar 5, 2020 — Due to SNMMI's diligence, CMS' National Correct Coding Initiative (NCCI) confirmed that its proposed Procedure to Procedure (PTP) edits for several of the new and revised CPT codes (effective January 1, 2020) will be corrected.

• SNMMI Hosts FDA Workshop

  Feb 18, 2020 — On Friday, February 21, SNMMI and the FDA will be hosting a workshop entitled "PET Drugs: A Workshop on Inspections Management and Regulatory Issues."

• Good News for Members on CMS PET NCD

  Nov 15, 2019 — After reviewing the NCDs for PET for Myocardial Perfusion and PET for Myocardial Viability, CMS clarified that PET quantitative myocardial blood flow is coverable under these NCDs.

• Good News for Nuclear Medicine in CMS Final 2020 MPFS and HOPPS Rules

  Nov 4, 2019 — On November 1, CMS issued its final rules for HOPPS and MPFS. Thanks to the joint efforts of SNMMI, partner societies, and members, we have great news about nuclear medicine reimbursement for the coming year. Find out more.

• 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.

• SNMMI/ASNC Alert: Important Drug Safety Information for Rubidium 82 Generators

  Apr 4, 2019 — Recently, there has been a report of high-level radiation exposure with use of incorrect eluent in Rubidium 82 Rb82 generators after a failure to follow the eluate testing protocol. ASNC and SNMMI members are reminded to use only additive-free, 0.9 % Sodium Chloride Injection, USP (normal saline) to elute the Rubidium 82 Rb82 generator.

• SNMMI Members Host Congressman Loebsack at University of Iowa Hospitals and Clinics

  Mar 18, 2019 — Congressman Loebsack and staff visited the PET and nuclear medicine facilities at the University of Iowa.

• FDA Updates Bulk Drug Substances List with Amino Acid Solutions

  Mar 4, 2019 — On March 1, the U.S. Food and Drug Administration announced updates to the categories of bulk drug substances under its interim policy under section 503B of the Federal Food, Drug, and Cosmetic Act. SNMMI commends the FDA for their swift action to update the 503B Bulk Drugs list, which will ultimately make it easier for manufacturers to compound and make available an arginine/lysine only solution.

• 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.