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Coding and Reimbursement

• FDA Fully Approves Leqembi for Alzheimer’s; CMS Unclear on PET Reimbursement

  Jul 10, 2023 — The FDA has granted full approval to Leqembi (lecanemab); however, CMS has not committed to reimbursement of the needed PET scans.

• Congress passes 2023 Consolidated Appropriations Act

  Dec 29, 2022 — On December 23, 2022, the U.S. House of Representatives passed H.R. 2617, the 2023 Consolidated Appropriations Act (also referred to as the Omnibus package) by a vote of 225-201-1.

• CMS Publishes 2023 MPFS and Hospital OPPS Final Rule

  Nov 22, 2022 — On November 1, CMS released the 2023 Medicare Physician Fee Schedule and Hospital Outpatient Prospective payment Final Rules.

• 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.

• 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).

• 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.

• 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.

• 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.

• 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.