September 3, 2019
Alarming proposals updating payment inputs for myocardial PET, potentially leading to technical component payment reductions as high as 80 percent for some services, were included in the proposed Medicare Physician Fee Schedule for 2020. These revisions result from updates to the current procedural terminology (CPT) codes used to report these services and review of the direct practice expense inputs that inform the calculation for the technical component payment.
One driver of the cuts is a decision by CMS to assume a 90 percent utilization rate for PET cameras, an assumption that needs to be reconsidered. Pricing information for other equipment also may need to be further refined. The American College of Cardiology (ACC), American College of Nuclear Medicine (ACNM), the American Society of Nuclear Cardiology (ASNC), Cardiology Advocacy Alliance (CAA) and SNMMI are actively working together on your behalf to address this significant issue.
While the ACC, ACNM, ASNC, CAA and SNMMI support the valuation process used to develop input recommendations administered by the American Medical Association's Relative Value Scale Update Committee (RUC), payment cuts of this magnitude and on such short notice are not sustainable and could lead to practice disruptions and impact patient access to PET services.
The ACC, ACNM, ASNC, CAA and SNMMI are aggressively working to correct the inputs and calculations for the payment formula through the public comment process and communication with policymakers. If it becomes clear this cannot be accomplished within the constraints of the rulemaking timeline, we will seek alternative approaches, such as a delay period, to allow further analysis and other efforts to continue.
Members who provide PET services can help ACC, ACNM, ASNC, CAA and SNMMI address this proposal in two ways.