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Coding and Reimbursement

• 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.

• SNMMI achieves policy change for wastage billing

  Dec 18, 2017 — A Medicare administrative contractor in the southern U.S. has agreed to a recommendation from the Society of Nuclear Medicine and Molecular Imaging (SNMMI) to allow providers to bill for wastage when single-dose vials of radiopharmaceuticals are used.

• SNMMI Solves Billing Problem in Much of South

  Dec 15, 2017 — Palmetto GBA, a Medicare administrative contractor, has agreed to make billing-policy changes that SNMMI requested regarding payment for wastage from single-dose vials of radiopharmaceuticals. These changes affect North Carolina, South Carolina, Virginia and West Virginia now, and will apply to the states that Palmetto will take over in 2018 (Alabama, Georgia and Tennessee).

• SNMMI Submits Comments to NRC on Naturally Occurring and Accelerator-Produced Radioactive Materials

  Nov 14, 2017 — SNMMI has submitted comments to the NRC on its open petition for rulemaking, asking that its regulations be revised to include radionuclides and their corresponding activities to the list of "Quantities of Licensed Material Requiring Labeling."

• SNMMI Commends FDA for Release of Microdose Guidance

  Nov 13, 2017 — SNMMI recently submitted comments to FDA on its draft guidance for microdose radiopharmaceutical diagnostic drugs.

• CMS Issues Final Rules for 2018

  Nov 3, 2017 — Final rules on Medicare for 2018 include the Physician Fee Schedule (PFS), Hospital Outpatient Prospective Payment System (OPPS) and Quality Payment Program (QPP). This is a preliminary summary of how the rules affect nuclear medicine and molecular imaging. There are some tweaks, but no major surprises or changes. For example, the mandate that referring physician consult Appropriate Use Criteria (AUCs) is pushed back from 2018 to 2020.

• Questions on Coding and Reimbursement? Visit the SNMMI Coding Corner!

  Oct 20, 2017 — SNMMI’s Coding Corner provides the most up-to-date and comprehensive source for nuclear medicine coding and reimbursement information on the web. In addition, the Coding and Reimbursement Q&A Section contains more than 120 questions and answers related to cardiology; NETS; oncology; PET, PET/CT and PET/MRI; pharmaceuticals and more. There’s also the option to ask new questions.

• American College of Emergency Physicians Endorses AUC for V/Q Imaging in Pulmonary Embolism

  May 25, 2017 — The American College of Emergency Physicians (ACEP) has endorsed SNMMI’s recently released appropriate use criteria (AUC) for ventilation/perfusion (V/Q) imaging in pulmonary embolism (PE). This is significant as emergency room physicians are the primary audience for this critically important procedure to diagnose or rule out PE.

• SNMMI Publishes Appropriate Use Criteria for Ventilation/Perfusion Imaging in Pulmonary Embolism

  May 1, 2017 — SNMMI has published appropriate use criteria for ventilation/perfusion (V/Q) imaging in pulmonary embolism. This is the second in a series of new AUC developed by SNMMI in its role as a qualified provider-led entity (PLE) under the Medicare Appropriate Use Criteria program for advanced diagnostic imaging.

• SNMMI Publishes Appropriate Use Criteria for Ventilation/Perfusion Imaging in Pulmonary Embolism

  May 1, 2017 — SNMMI has released appropriate use criteria for ventilation/perfusion (V/Q) imaging in pulmonary embolism. This is the second in a series of new AUC developed by SNMMI in its role as a qualified provider-led entity (PLE) under the Medicare Appropriate Use Criteria program for advanced diagnostic imaging.

• SNMMI Begins Release of Appropriate Use Criteria for High-Value Nuclear Medicine Procedures

  Apr 6, 2017 — SNMMI has released a new appropriate use criteria (AUC) for bone scintigraphy in prostate and breast cancer, the two most common diagnoses for which bone scans are ordered in the adult population. This is the first in a series of new AUC developed by SNMMI in its role as a qualified provider-led entity (PLE) under the Medicare Appropriate Use Criteria Program for advanced diagnostic imaging.

• SNMMI Publishes Appropriate Use Criteria for Bone Scintigraphy in Prostate and Breast Cancer

  Apr 6, 2017 — SNMMI has released a new AUC for bone scintigraphy in prostate and breast cancer. This is the first in a series of new AUC developed by SNMMI in its role as a Medicare qualified provider-led entity. Beginning January 1, 2018, all referring physicians or ordering professionals are required to consult appropriate use criteria using a clinical decision support mechanism before ordering any nuclear medicine study.

• 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.

• Passage of the 21st Century Cures Act: What It Means

  Dec 8, 2016 — Both the House and Senate have passed the 21st Century Cures legislation, which President Obama has said he will sign into law.

• 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.

• “Pick your Pace” for MACRA Participation

  Nov 30, 2016 — The Centers for Medicare and Medicaid Services (CMS) is rolling out a “Pick Your Pace” system to help clinicians make the transition to a new payment system.

• 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.

• Medicare Physician Compare Period Open Through November 11, 2016

  Oct 17, 2016 — Physician Compare allows clinicians and group practices to preview their performance scores for select 2015 Physician Quality Reporting System (PQRS) measures and Consumer Assessment of Healthcare Providers and Systems (CAHPS) for PQRS measures before they are publicly reported on Physician Compare later this year.

• CMS Releases Final Rule for MACRA

  Oct 17, 2016 — The U.S. Centers for Medicare and Medicaid Services (CMS) has released its final rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA ends the Sustainable Growth Rate formula for updates to the physician fee schedule, which threatened clinicians participating in Medicare with potential payment cliffs for 13 years. It replaces it with the Quality Payment Program, which rewards the delivery of high-quality patient care.

• SNMMI Submits Comments on FDA Compounding Draft Guidance

  Oct 13, 2016 — SNMMI has submitted comments to FDA regarding the Draft Guidance for Industry: Insanitary Conditions at Compounding Facilities.

• SNMMI Submits Comments to CMS Regarding CY 2017 Proposed Rules for HOPPS and MPFS

  Sep 1, 2016 — The Society recently submitted comments to the Centers for Medicare and Medicaid Services on two proposed rules.

• Imaging Drug Development - FDA Regulatory Issues Presentation Available to Members

  Aug 1, 2016 — The society has been given permission by the Food and Drug Administration to share the "Imaging Drug Development - FDA Regulatory Issues" presentation from SNMMI's 2016 Annual Meeting.

• SNMMI Presents at NRC Stakeholders Meeting

  Jul 27, 2016 — The Society recently presented at a high-level stakeholders meeting on July 26, 2016.

• Thomas Hope and Prashant Jolepalem Chosen as Recipients of the 2016 Henkin Fellowship

  Mar 1, 2016 — SNMMI and the Education and Research Foundation for Nuclear Medicine and Molecular Imaging are pleased to announce that Thomas Hope, MD, and Prashant Jolepalem, MD, CCD, are the recipients of the 2016 Robert E. Henkin Government Relations Fellowship.

• Cardiologist Nominated to Be Head of FDA

  Feb 25, 2016 — On Tuesday February 24, the Obama administration nominated Dr. Robert Califf, a cardiologist and clinical researcher long affiliated with Duke University, to be the commissioner of the Food and Drug Administration.

• SNMMI Comments on USP General Chapter 797 Pharmaceutical Compounding

  Feb 24, 2016 — On February 24, 2016, SNMMI submitted comments to USP on General Chapter 797 Pharmaceutical Compounding - Sterile Preparations.

• The Joint Commission Revises Standards for Diagnostic Imaging Services

  Feb 17, 2016 — On February 16, 2016, the Joint Commission (TJC) approved new Standards for Diagnostic Imaging Services for hospitals, critical access hospitals, and ambulatory care organizations. Effective September 1, 2016.

• SNMMI Submits Comments to NRC on I-131 Patient Release

  Feb 16, 2016 — On Tuesday, February 16, SNMMI submitted comments to the U.S. Nuclear Regulatory Commission (NRC) on a number of issues associated with medical treatment of patients with sodium iodide I–131.

• SNMMI Submits Comments to CMS Regarding CY 2016 Final Rules for HOPPS and MPFS

  Dec 16, 2015 — On Wednesday, December 16, SNMMI submitted comments to CMS on the CY 2016 Final Rules for the Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Physician Fee Schedule (MPFS).

• USP Call for Candidates: Radioactive Drugs Expert Panel

  Nov 30, 2015 — The US Pharmacopeia (USP) is currently in the process of forming a Radioactive Drugs Expert Panel. The call for members of this Panel is now open and the deadline to apply is December 20th.

• NRC Seeks Information Regarding I-131 Patient Release

  Nov 16, 2015 — The U.S. Nuclear Regulatory Commission is seeking information from the public regarding sodium iodine-131 patient release practices and standards.

• CMS Releases CY 2016 HOPPS & MPFS Final Rules - Effective January 1, 2016

  Nov 11, 2015 — On October 30, CMS released the CY 2015 Final Rules for the Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Physician Fee Schedule.

• USP Seeking Comments on General Chapter Revisions: Deadline approaching!

  Nov 9, 2015 — The US Pharmacopeia (USP) is currently in the process of revising several general chapters that are important to the nuclear medicine community.

• CMS Creates Modifier to Enforce XR-29 Radiation Dose Penalties

  Nov 9, 2015 — The Protecting Access to Medicare Act (PAMA) established radiation dose requirements that will take effect on January 1, 2016.

• Bipartisan Budget Agreement - Hospital Outpatient Payment Change Included

  Oct 30, 2015 — Lawmakers have negotiated an agreement on a two-year budget package which would lift federal spending caps for two years, increasing discretionary spending by $80 billion.

• SNMMI Submits Comments on CMS Proposed Decision Memo for NaF-18 PET

  Oct 16, 2015 — SNMMI submitted comments to CMS regarding the Proposed Decision Memo on Positron Emission Tomography (NaF-18) to identify bone metastasis of cancer.

• SNMMI's 2015 Patient Advocacy Hill Day

  Oct 1, 2015 — On Monday, September 28, 2015, SNMMI, patient advocates, and members of the Patient Advocacy Advisory Board, met with 42 Congressional offices for SNMMI's 2015 Patient Hill Day.

• CMS News: MACRA - New Opportunities

  Sep 29, 2015 — CMS released a Request for Information (RFI) to seek public comment related to new provisions in the Medicare Access and CHIP Reauthorization Act of 2015.

• SNMMI Submits Comments to CMS Regarding CY 2016 Proposed Rules for HOPPS and MPFS

  Aug 26, 2015 — On Wednesday, August 26, SNMMI submitted comments to CMS on the CY 2016 Proposed Rules for the Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Physician Fee Schedule (MPFS).

• CMS & AMA Announce Efforts to Help Providers Prepare For ICD-10

  Jul 7, 2015 — On July 6, CMS and the AMA announced efforts to help providers prepare to transition from ICD-9 to ICD-10 coding.

• CMS Releases the CY 2016 HOPPS Proposed Rule

  Jul 2, 2015 — On July 1, 2015, CMS released the CY 2016 Hospital Outpatient Prospective Payment System proposed rule.

• SNMMI Releases Executive Summary from FDA Stakeholder Meeting

  May 20, 2015 — SNMMI finalized its executive summary of the broad FDA Stakeholder meeting held in the fall of 2014.

• President Signs Legislation to Replace the SGR

  Apr 16, 2015 — On April 16, President Obama signed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015. This legislation will replace Medicare's SGR formula before CMS begins processing a 21% cut to physician reimbursements.

• SNMMI Submits Comments on Ending Data Collection for NaF-18 PET

  Apr 8, 2015 — SNMMI submitted comments to CMS regarding NOPR's request to reconsider a national coverage policy for positron emission tomography (18F-NaF PET) to identify bone metastasis of cancer.

• Congress Adjourns for Spring Recess Without Passing SGR Legislation

  Mar 30, 2015 — Congress adjourned for their spring recess without passing legislation that would permanently repeal Medicare's sustainable growth rate (SGR) and provide incentives for doctors to focus on value-driven care.

• Congress Introduces New SGR Repeal Legislation

  Mar 19, 2015 — Congress has introduced bipartisan, bicameral legislation would permanently repeal Medicare's sustainable growth rate (SGR) and provide incentives for doctors to focus on value-driven care.

• CMS Requests Comments on Ending Data Collection for NaF-18 PET

  Mar 18, 2015 — CMS has solicited public comments regarding NOPR's request to end the prospective data collection requirements under CED for use of NaF-18 PET imaging in intended patient management.

• Deadline Looms for SGR Appeal

  Mar 11, 2015 — With the year-long patch set to expire on April 1, 2015, Congress must pass SGR legislation to prevent a 21 percent pay cut to Medicare physicians.

• SNMMI Submits Comments to CMS for CY2015 HOPPS & MPFS Final Rules

  Jan 6, 2015 — SNMMI submitted comments to CMS regarding the CY15 Final Rules for HOPPS and MPFS. Both rules were due no later than 5pm ET on Wednesday, December 31, 2014.

• CMS Releases CY 2015 HOPPS & MPFS Final Rules

  Oct 31, 2014 — On October 31, CMS released the CY 2015 Final Rules for the Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Physician Fee Schedule.

• Highlights of SNMMI’s FDA Stakeholder Meeting

  Oct 30, 2014 — On October 27, 2014, SNMMI hosted a broad stakeholder meeting in Linthicum Heights, Md. The society brought in more than 40 experts from the field of nuclear medicine and molecular imaging to discuss the current regulatory climate.

• SNMMI Submits Comments to TJC

  Oct 17, 2014 — On October 17, SNMMI submitted comments to The Joint Committee (TJC) regarding proposed revisions to diagnostic imaging services.

• Mallinckrodt to Increase Prices

  Oct 13, 2014 — Mallinckrodt informed customers that, due to some of the significant cost drivers that the nuclear medicine industry is experiencing, they will be increasing prices over the next several years.

• Upcoming Freeze on Claims for FDG PET for Solid Tumors

  Oct 6, 2014 — CMS has announced a temporary processing freeze on claims submitted for FDG PET for Solid Tumors between October 6 and November 10.

• Update on Kinevac Availability

  Sep 17, 2014 — Bracco Diagnostics Inc. announced that production is moving forward with targeted efforts for Kinevac commercial availability by the end of September.

• Upcoming Webinar: Oncologic PET Coding & Reimbursement

  Aug 20, 2014 — On September 23, 2014, Merlino Health Care Consulting Corp. will hold the webinar "Oncologic PET Coding & Reimbursement, Where Are We Today?"

• CMS Releases CY 2015 Hospital Outpatient Prospective Payment System Proposed Rule

  Jul 3, 2014 — On July 3, 2014, CMS released the CY 2015 HOPPS proposed rule.

• CMS Releases CY 2015 Medicare Physician Fee Schedule Proposed Rule

  Jul 3, 2014 — On July 3, 2014, CMS issued a proposed rule that would update payment policies and payment rates for services furnished under the MPFS on or after Jan. 1, 2015.

• CMS Releases Instructions Related to the NCD to End the Coverage with Evidence Development Requirement for FDG PET for Solid Tumors

  Jul 1, 2014 — CMS has released instructions to Medicare Administrative Contractors regarding the processing of claims pursuant to the June 11, 2013 final decision to end the coverage with evidence development (CED) requirement for certain FDG PET studies for solid tumors.

• CMS Releases Final Rule Concerning Direct Supervision

  May 8, 2014 — On May 7, 2014, CMS released the Final Rule for Part II Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction. This new rule finalized the previously proposed change of removing the term “direct" from the current requirement at § 482.53(b)(1).

• SNMMI Releases Q&A Regarding the Price Increase for Macroaggregated Albumin (MAA)

  Apr 23, 2014 — SNMMI has released a Coding Corner Q&A in response to the drastic price increase that went into effect on April 1, 2014 for macroaggregated albumin (MAA).

• CMS Releases Instructions on the NCD for Beta Amyloid PET in Dementia and Neurodegenerative Disease

  Feb 24, 2014 — CMS has released instructions to contractors related to its National Coverage Determination for Beta Amyloid PET in Dementia and Neurodegenerative Disease.

• SNMMI Submits Comments to CMS on CY 2014 HOPPS & MPFS Final Rules

  Jan 29, 2014 — On January 27, SNMMI submitted comments to CMS on the CY 2014 HOPPS & MPFS Final Rules.

• CMS Edits on the Ordering/Referring Providers in Medicare

  Nov 27, 2013 — If you order or refer items or services for Medicare beneficiaries and you do not have a Medicare enrollment record, you need to submit an enrollment application to Medicare.

• CMS Releases CY2014 Medicare Physician Fee Schedule Final Rule

  Nov 27, 2013 — On November 27, 2013, CMS finalized updates to payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule.

• CMS Releases CY2014 Hospital Outpatient Prospective Payment System Final Rule

  Nov 27, 2013 — On November 27, 2013, CMS issued the final Calendar Year 2014 HOPPS and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates final rule.

• Medicare Claims for FDG PET Studies with DOS

  Oct 9, 2013 — Effective June 11, 2013, CMS ended the coverage with evidence development (CED) requirement for F-18 fluorodeoxyglucose positron emission tomography (FDG PET) and FDG PET/CT for all oncologic indications contained in section 220.6.17 of the Medicare National Coverage Determinations (NCD) Manual.

• SNMMI Submits Comments to CMS Regarding CY 2014 Proposed Rules for HOPPS and MPFS

  Sep 6, 2013 — On Friday, September 6, SNMMI submitted comments to CMS on the CY 2014 Proposed Rules for the Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Physician Fee Schedule (MPFS).

• FDG Positron Emission Tomography for Solid Tumors and Myeloma: Data Collection Ends Under the National Oncologic PET Registry

  Jul 9, 2013 — Effective June 11, 2013, CMS ended the coverage with evidence development (CED) requirement for F-18 fluorodeoxyglucose positron emission tomography (FDG PET) and FDG PET/CT for all oncologic indications contained in section 220.6.17 of the Medicare National Coverage Determinations (NCD) Manual.

• Updated: Complimentary Webinar for Positron Emission Tomography Imaging for Solid Tumors

  Jul 2, 2013 — SNMMI held a webinar to review and discuss the Centers for Medicare & Medicaid Services (CMS) final PET coverage decision to end coverage with evidence development (CED) for NOPR-covered FDG PET indications (CAG-00181R4), that was released on Tuesday, June 11th, 2013.

• CMS Releases Final Decision Memo for Positron Emission Tomography (FDG) for Solid Tumors

  Jun 11, 2013 — Today CMS posted a final decision to end the coverage with evidence development requirement for FDG PET for solid tumors (CAG-00181R4).

• AMA CPT Category III Codes Effective on July 1, 2013

  Jun 3, 2013 — The 2013-14 Current Procedural Terminology (CPT) electronic Category III file was released by the American Medical Association (AMA) on December 27, 2012.

• CMS HCPCS Level II Codes Effective January 1, 2013

  Nov 27, 2012 — The 2013 Healthcare Common Procedure Coding System (HCPCS) electronic file has been posted with updated file information on the Centers for Medicare and Medicaid Services (CMS) web site.

• CMS Issues CY 2013 Hospital Outpatient Prospective Payment System Proposed Rule

  Jul 6, 2012 — The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) beginning Jan. 1, 2013.

• CMS Issues Proposed Rule for Reporting and Returning of Overpayments

  Feb 23, 2012 — CMS has issued a proposed rule implementing the requirements for reporting and returning overpayments set forth in the Affordable Care Act.

• CMS Issues New POS Guidance

  Feb 21, 2012 — The Centers for Medicare & Medicaid Services (CMS) has provided new Place of Service (POS) guidance in Change Request (CR) 7631 (Transmittal 2407) effective on April 1, 2012.