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Coding and Reimbursement

• 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).

• NCCI Completes SNMMI's Proposed Changes to PTP Edits

  Dec 7, 2021 — CMS's National Correct Coding Initiative issued procedure-to-procedure edit corrections requested by SNMMI for several of the new and revised CPT codes, retroactive for claims with a date of service January 1, 2020, or after.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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."

• 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.