Imaging advocates report progress addressing Medicare PET/CT payment problem
Days after pressing the Centers for Medicare & Medicaid Services to expand PET imaging payment, radiology advocates received some good news this week.
The Society of Nuclear Medicine & Molecular Imaging and American College of Radiology recently reached out to one Medicare Administrative Contractor to express concerns about coverage. And National Government Services has responded that it’s now taking a closer look at the issue.
“We are reviewing the PET scan pricings,” Stephen Boren, MD, medical director of the of NGS, whose jurisdiction covers three states in the Midwest and seven more in the Northeast, wrote in a response to SNMMI.
“We agree that PET CT should be reimbursed higher than PET alone. We will be making some changes in reimbursement,” he added, according to a Tuesday news update from the molecular imaging group.
The original May 11 letter from radiology advocates cited a list of concerns related to payment for myocardial positron emission tomography. Those included receiving extra compensation for more complicated procedures and avoiding any new restrictions on office-based delivery of these exams.
“We strongly recommend that [National Government Services] determine appropriate rates for the myocardial PET procedures by recognizing that within the family of codes, there is a hierarchy in the complexity, time to perform and resource costs of the procedures,” the medical groups wrote last week.
Boren did not immediately respond to a Radiology Business request for comment on Wednesday. National Government Services’ jurisdiction includes Illinois, Minnesota and Wisconsin along with Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.
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.