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Coding and Reimbursement

• NCCI Implements Some of SNMMI's Proposed Changes to PTP Edits

  Mar 4, 2021 — On March 1, 2021, CMS' National Correct Coding Initiative (NCCI) implemented several Procedure to Procedure (PTP) edits proposed by SNMMI for several of the new and revised CPT codes. These edits are retroactively effective January 1, 2020.

• SNMMI & Coalition Partners Gather to Discuss the Importance of Providing Access to Advanced Nuclear Imaging Procedures

  Mar 3, 2021 — Today, SNMMI along with the Medical Imaging & Technology Alliance (MITA) and the Council on Radionuclides and Radiopharmaceuticals, Inc. (CORAR), hosted a virtual briefing with physicians, patients, and industry representatives. Discussions centered on the need to provide patient access to innovative nuclear diagnostics and the growing role of positron emission tomography (PET), single-photon emission computerized tomography (SPECT), and nuclear medicine in detecting prostate cancer, Parkinson’s, Alzheimer’s and other life-threatening diseases.

• 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.

• SNMMI & Partners Urge Congress to Waive Budget Neutrality for MPFS Beyond 2021

  Feb 23, 2021 — SNMMI and 74 other organizations urged legislators to consider additional policy options in the year ahead to address shortcomings in physician reimbursement.

• CMS Confirms HOPPS Payment Rate Error for CERIANNA™ (Fluoroestradiol F-18) Injection

  Feb 22, 2021 — SNMMI has been working with Zionexa to seek proper Medicare reimbursement for Cerianna, radiolabeled 18F-fluoroestradiol indicated for use with positron emission tomography (PET) imaging for detection of estrogen receptor–positive lesions as an adjunct to biopsy in patients with recurrent or metastatic breast cancer. As of January 2021, the HOPPS published rate for this product is incorrect.

• Detectnet™ (Copper Cu-64 Dotatate Injection) Gets a New HCPCS Level II Code

  Feb 10, 2021 — Recently, the Centers of Medicare and Medicare and Medicaid Services (CMS) granted Detectnet™ a HCPCS Level II Code, A9592 (copper cu-64, dotatate, diagnostic, 1 millicurie), effective April 1, 2021.

• President Signs 2021 Appropriations Act, Supplements Physician Reimbursement, Provides COVID-19 Relief

  Dec 27, 2020 — Today, President Trump signed the Coronavirus Response and Relief Supplemental Consolidated Appropriations Act of 2021 into law. The House (359 to 53) and Senate (91 to 7) passed the legislation by a vote of 359 to 53 on December 22. This is good news for physician reimbursement.

• SNMMI and Coalition Support Bill Waiving Budget Neutrality in New Senate Bill

  Dec 15, 2020 — Yesterday, SNMMI and a coalition consisting of 77 medical societies sent a letter to Congress in support of S. 5007, a bill to halt pending Medicare payment cuts resulting from the planned evaluation and management (E/M) code changes slated for implementation on January 1, 2021.

• Final 2021 MPFS Rule Fails to Provide Relief, SNMMI and Coalition Lobby Congress to Protect Physician Reimbursement and Access to Care

  Dec 2, 2020 — Yesterday evening, December 1, the Centers for Medicare and Medicaid Services (CMS) released the calendar year 2021 Medicare Physician Fee Schedule (MPFS) final rule. Though SNMMI agrees with the adoption of the new evaluation and management (E/M) coding structure recommended by the American Medical Association (AMA), this will result in significant payment reductions to nuclear medicine (~8%) and radiology (~11%) services unless the government removes the budget neutrality requirements.

• SNMMI Objects to Humana’s Decision to Deny Coverage for PET/CT & SPECT/CT

  Nov 12, 2020 — On November 6, SNMMI received word regarding Humana’s recent decision [Policy Number: HCS-0506-010] to deny coverage for PET/CT (CPT codes 78429-78433) and SPECT/CT (78830, 78832) on the basis that it is “experimental/investigational” and “not identified as widely used and generally accepted for the proposed uses as reported in nationally recognized peer-reviewed medical literature.”

• SNMMI and Coalition Support Bill Waiving Budget Neutrality, Increasing Proposed Physician Reimbursement for 2021

  Nov 11, 2020 — Today, SNMMI and a coalition consisting of 73 medical societies sent a letter to Congress in support of H.R. 8702, a bill to halt pending Medicare payment cuts resulting from the planned evaluation and management (E/M) code changes slated for implementation on January 1, 2021.

• SNMMI and Partners Ask Congress to Waive Budget Neutrality for MPFS

  Oct 13, 2020 — On Friday, SNMMI and several medical societies sent a joint letter asking Congress to waive budget neutrality for the relative value unit increases in the CY 2021 Medicare Physician Fee Schedule. The CMS Proposed CY 2021 MPFS Rule increased payment rates for evaluation and management codes; however, because of budget neutrality imposed by Congress, increases would lead to huge deficits other payment rates.

• SNMMI Comments on 2021 MPFS Proposed Rule

  Sep 30, 2020 — On Monday, August 3, the Centers for Medicare and Medicaid Services (CMS) released the calendar year 2021 Medicare Physician Fee Schedule (MPFS) proposed rule. Though SNMMI agrees with the adoption of the new evaluation and management (E/M) coding structure recommended by the American Medical Association (AMA), this will result in significant payment reductions to nuclear medicine (~8%) and radiology (~11%) services unless the government removes the budget neutrality requirements.

• SNMMI and Partners Host Congressional Briefing on the Groundbreaking Potential of Radiopharmaceuticals in Oncology and Need for Expanded Patient Access

  Sep 17, 2020 — Yesterday, SNMMI and its coalition partners, Medical Imaging & Technology Alliance (MITA) and Council on Radionuclides and Radiopharmaceuticals, Inc. (CORAR) hosted a virtual briefing for Capitol Hill staff yesterday with leading physicians to discuss the extraordinary and growing impact of positron emission tomography (PET) and nuclear medicine in cancer treatment, as well as the importance of expanding patient access to these drugs through passage of the Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019 (H.R. 3772).

• CMS extends the AUC Program Educational and Operations Testing Period through CY 2021

  Aug 11, 2020 — The Centers for Medicare and Medicaid Services (CMS) has provided an update regarding the Appropriate Use Criteria (AUC) Program established by The Protecting Access to Medicare Act (PAMA) of 2014.

• CMS Releases 2021 MPFS Proposed Rule

  Aug 4, 2020 — On August 3, CMS released the 2021 Medicare Physician Fee Schedule proposed rule. In this rule, CMS proposed changes to the payment provisions, introduced new coding structure for the evaluation and management codes and updated the Quality Payment Program.

• Recent HHS Updates During the COVID-19 Pandemic

  May 19, 2020 — As we wait the enactment of a fourth stimulus package, SNMMI would like to inform its membership of the recent U.S. Department of Health and Human Services (HHS) administrative updates as a result of COVID-19.

• SNMMI Advocates for Access to Diagnostic Radiopharmaceuticals through COVID-19 and Beyond

  May 15, 2020 — This week SNMMI and its coalition partners sent a letter imploring Congress to take immediate action to ensure patient access to FDA-approved diagnostic radiopharmaceutical drugs that aid in the detection of cancer, cardiovascular conditions and neurological disorders.

• Congressman Greg Murphy, MD, Signs On to the Medicare Diagnostic Radiopharmaceutical Payment Equity Act

  Apr 16, 2020 — Last week, SNMMI had the chance to sit down and talk with Congressman Greg Murphy, MD, a urologist representing North Carolina’s 3rd Congressional district. Congressman Murphy is the first physician to sign on to HR 3772, the Medicare Diagnostic Radiopharmaceutical Payment Equity Act.

• NCCI Agrees with SNMMI's Proposed Changes to Edits PTP Errors

  Mar 5, 2020 — Due to SNMMI's diligence, CMS' National Correct Coding Initiative (NCCI) confirmed that its proposed Procedure to Procedure (PTP) edits for several of the new and revised CPT codes (effective January 1, 2020) will be corrected.

• NCCI Agrees with SNMMI's Proposed Changes to PTP Edits

  Mar 5, 2020 — Due to SNMMI's diligence, CMS' National Correct Coding Initiative (NCCI) confirmed that its proposed Procedure to Procedure (PTP) edits for several of the new and revised CPT codes (effective January 1, 2020) will be corrected.

• SNMMI Hosts FDA Workshop

  Feb 18, 2020 — On Friday, February 21, SNMMI and the FDA will be hosting a workshop entitled "PET Drugs: A Workshop on Inspections Management and Regulatory Issues."

• 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.

• 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.