CMS erects ‘unexpected’ new barriers to payment for PET imaging in certain scenarios
Imaging advocates are expressing dismay after the Centers for Medicare & Medicaid Services recently erected new barriers preventing payment for PET scans examining inflammation and infection.
Back in March, the Society of Nuclear Medicine & Molecular Imaging expressed excitement, with the federal agency relenting after refusing to cover such scans for more than a decade. However, SNMMI had to walk back its comments on Tuesday after a recent federal update.
CMS published an updated list of nationally covered imaging indications on June 8. “Unexpectedly,” SNMMI said, codes for some imaging of osteomyelitis (an infection of the bone) and “fever of unknown origin” are listed as not covered.
“The information in this transmittal is contrary to our understanding of the January 1, 2021, retirement of the infection and inflammation [National Coverage Determination],” the society said in a June 29 news alert. “SNMMI is working with CMS to clarify, potentially reverse, and obtain more information for our members regarding this unanticipated and conflicting information in the transmittal.”
CMS first ceased coverage of fluorodeoxyglucose (FDG) PET imaging for infection and inflammation in 2008, citing scant evidence at the time. SNMMI, the American College of Radiology, and the American Society of Nuclear Cardiology have crusaded to reverse the decision, with the feds revoking the noncoverage determination in December. Experts said previously that the 2008 change has “severely” limited PET use in these clinical scenarios since then.
This month’s transmittal is binding on Medicare Administrative Contractors, and these indications are not currently being covered by MACs, experts noted.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.