Since 2008, Medicare has “packaged” payment for diagnostic radiopharmaceuticals into payment for the molecular imaging tests conducted by nuclear medicine providers in hospital outpatient facilities. Physicians use these tests to diagnose cancer and cardiac conditions, as well as degenerative neurological diseases such as Parkinson’s and Alzheimer’s diseases, and determine the appropriate course of treatment for their patients.
Medicare’s packaged rates for such studies are the same regardless of whether they involve a high-volume, lower-cost diagnostic radiopharmaceutical or a low-volume, higher-value precision diagnostic tool that can facilitate more targeted treatment -- even when the cost of the precision medicine drug can substantially exceed the entire packaged reimbursement.
Unfortunately, Congress did not pass the Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019 (H.R. 3772). However, now that we are in a new legislative session, SNMMI and its coalition partners are working to introduce a new bill for 2021. This bill would ensure that Medicare patients have access to precision diagnostic imaging studies prescribed by their physicians when clinically appropriate, and that hospitals are appropriately reimbursed for the cost of such tests.
We are seeking providers and patient advocates! To participate in virtual or in-person Congressional fly-ins and/or briefings, please contact firstname.lastname@example.org.
Historical Documentation on HR. 3772
Events and activities related to H.R. 3772 may be found on our Government Relations News page.
Section by Section Analysis of the Legislation
Section 1. Short Title. Bill title.
Section 2(a). Separate Payment for Certain Diagnostic Radiopharmaceuticals.
Section 2(a) would add a provision to Medicare’s Hospital Outpatient Prospective Payment System (OPPS system) to:
Section 2(b). No Impact on Copayment.
This section would ensure that Medicare beneficiaries will not incur an additional copayment obligation for separately paid Dx RPs.