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Coding and Reimbursement

• Good News for Members on CMS PET NCD

  Nov 15, 2019 — After reviewing the NCDs for PET for Myocardial Perfusion and PET for Myocardial Viability, CMS clarified that PET quantitative myocardial blood flow is coverable under these NCDs.

• Good News for Nuclear Medicine in CMS Final 2020 MPFS and HOPPS Rules

  Nov 4, 2019 — On November 1, CMS issued its final rules for HOPPS and MPFS. Thanks to the joint efforts of SNMMI, partner societies, and members, we have great news about nuclear medicine reimbursement for the coming year. Find out more.

• Members: Thank You for Your Efforts to Protect Cardiac PET

  Oct 2, 2019 — Thank you to all the SNMMI members who sent messages to Congress and comments to the Centers for Medicare and Medicaid Services about its proposal to reduce reimbursement by up to 80 percent for myocardial PET in the office setting.

• Joint Society Call to Action: Congressional Sign On Letter to CMS Addresses Proposed PET Cuts, Patient Impacts

  Sep 23, 2019 — As we continue our many efforts to address the cuts proposed in the Medicare Physician Fee Schedule, we need your help! Most recently, the ACC, ASNC, CAA, SNMMI and ACNM have secured a Congressional sign-on letter to the Center for Medicare and Medicaid Services (CMS) by Reps. Mike Kelly, (R-PA), Ron Estes (R-KS), and Ron Kind, (D-WI). As members, we urge you to write, call, or email your representatives and senators and ask them to sign the letter and voice concerns with CMS directly.

• SNMMI Call to Action: Submit Your Comments on Medicare Proposed Rules

  Sep 18, 2019 — The society—along with the American College of Nuclear Medicine—have already submitted comments alerting CMS to the impact of these proposals. We need your help in submitting comments as well. CMS needs to hear how these proposals impact your profession and patient care.

• ACC, ACNM, ASNC, CAA and SNMMI Respond Strongly to Myocardial PET Cuts

  Sep 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. SNMMI and other medical societies are working to correct the inputs for the payment formula through the public comment process and direct communication with policymakers.

• 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.

• SNMMI/ASNC Alert: Important Drug Safety Information for Rubidium 82 Generators

  Apr 4, 2019 — Recently, there has been a report of high-level radiation exposure with use of incorrect eluent in Rubidium 82 Rb82 generators after a failure to follow the eluate testing protocol. ASNC and SNMMI members are reminded to use only additive-free, 0.9 % Sodium Chloride Injection, USP (normal saline) to elute the Rubidium 82 Rb82 generator.

• SNMMI Members Host Congressman Loebsack at University of Iowa Hospitals and Clinics

  Mar 18, 2019 — Congressman Loebsack and staff visited the PET and nuclear medicine facilities at the University of Iowa.

• FDA Updates Bulk Drug Substances List with Amino Acid Solutions

  Mar 4, 2019 — On March 1, the U.S. Food and Drug Administration announced updates to the categories of bulk drug substances under its interim policy under section 503B of the Federal Food, Drug, and Cosmetic Act. SNMMI commends the FDA for their swift action to update the 503B Bulk Drugs list, which will ultimately make it easier for manufacturers to compound and make available an arginine/lysine only solution.

• SNMMI-ACNM-ASTRO Submit Joint Comments to NRC on Training and Experience Requirements

  Jul 10, 2018 — SNMMI together with representatives from ACNM and ASTRO offered recommendations for potential updates to the Nuclear Regulatory Commission’s requirements for those who wish to be authorized users of unsealed byproduct material.

• The AMA's RUC and Why It Is Important to You

  Jun 12, 2018 — The American Medical Association (AMA) has an expert panel called the Relative Value Scale Update Committee (RUC), which advocates for accurate valuation of all physician services. If you receive a request from SNMMI to participate in an AMA RUC survey, it is imperative that you participate so your voice can be heard.

• WMIS, ACR and SNMMI Urge CMS to Reopen Reconsideration for NaF PET

  Jun 7, 2018 — Medicare patients with metastatic cancers may be negatively impacted by the recent decision of the Centers for Medicare & Medicaid Services (CMS) to decline to provide coverage for 18F-sodium fluoride positron emission tomography (NaF PET) imaging.

• Comments Sent to FDA Regarding Amino Acids Needed During Lu-177 DOTATATE Therapy

  May 29, 2018 — SNMMI, the Mayo Clinic, Washington University School of Medicine in St. Louis, and Memorial Sloan Kettering Cancer Center have jointly filed comments with the FDA with recommendations for regulatory changes that would make it easier for patients with GEP-NETs to obtain arginine and lysine--amino acids that can mitigate side effects of Lu-177 DOTATATE therapy.

• SNMMI Advocates for Improved Reimbursement at CMS Public Meeting

  May 21, 2018 — SNMMI recently advocated on behalf of members and their patients at the Centers for Medicare and Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS) workgroup public meeting. Lu-177-dotatate, Ga-68-dotatate, and Fl-18-fluciclovine are all delivered by pharmacies in per-study doses, not per-unit doses; SNMMI requested that CMS modify the coding descriptors for payment accordingly.

• 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.

• 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.