SNMMI's Voice Heard in Medicare Local Coverage Decision

May 15, 2019

Last summer, SNMMI submitted comments to First Coast Service Options, the Medicare Administrative Contractor for Florida, Puerto Rico, and the US Virgin Islands. In SNMMI's comment letter, the society requested First Coast rescind and not finalize its draft policy (DL37804) that would have withdrawn coverage for SPECT studies using I-123 ioflupane, also known as  DaTScan. I-123 Ioflupane is a radiopharmaceutical indicated for striatal dopamine transporter visualization using single-photon emission computed tomography (SPECT) brain imaging to assist in the evaluation of adult patients with suspected parkinsonian syndromes.

Earlier this month, FCSO announced that effective May 2, 2019, draft policy DL37804 will be retired due to the review of the comments submitted to FCSO during the comment period last year. A retirement of this non-coverage policy means that SNMMI members that are performing SPECT I-123 Ioflupane (aka DaTScan Imaging) for the FDA covered indications should now receive payment from FCSO. Members be also wish to share this coverage change notice with private payers that also had non-coverage, as most often a reversal by Medicare often yields reversals by private payers. 

SNMMI will continue to fight for adequate coverage and reimbursement for radiopharmacueticals essential in diagnosing and treating patients.