Bipartisan senators urge CMS to bolster access to nuclear imaging in outpatient settings
A bipartisan group of U.S. senators is urging the Centers for Medicare & Medicaid Services to bolster access to certain imaging exams in hospital outpatient settings.
Lawmakers led by Sen. Marsha Blackburn, R-Tenn., made their plea in a June 20 letter to the head of CMS. They expressed their support for Medicare beneficiary access to nuclear exams such as positron emission tomography (PET) and single photon emission computed tomography (SPECT). While the agency has taken action to address this issue—including recent changes to coverage determinations—availability remains inadequate.
“We ask that you advance this work during the [calendar year 2025 Outpatient Prospective Payment System] process so that patients can receive these PET and SPECT scans more widely in the hospital outpatient settings,” Blackburn and 14 others wrote to Administrator Chiquita Brooks-LaSure.
Lawmakers highlighted Alzheimer’s disease as an important example of this issue. Delayed access to amyloid PET scans can mean more Medicare beneficiaries potentially lose the opportunity to qualify for treatment as their disease progresses. Under the agency’s Imaging Dementia–Evidence for Amyloid Scanning (IDEAS) study, PET scans changed care plans in over 60% of patients initially characterized as having mild cognitive impairment. In the early study phases, when payment was equal across all imaging settings, 140 hospital outpatient facilities participated. However, during the subsequent rounds of the analysis, only 19 hospital outpatient sites took part, “due to decreased reimbursement as the radiopharmaceuticals had lost separate payment status.”
Imaging advocacy groups have for years pushed CMS to allow for separate payment for these drugs, rather than packaging them together with the procedure. ACR highlighted the senators’ letter in a June 27 update to its members.
“The American College of Radiology long supported addressing the packaging of payment for diagnostic radiopharmaceuticals so that beneficiaries have access to the care they need,” ACR noted. “The college continues to advocate with other organizations to ensure CMS includes something on this issue in upcoming rulemaking.”
Blackburn and colleagues said they also have heard from patients and providers about similar access issues affecting those seeking nuclear medicine scans for Parkinson’s, prostate cancer and certain cardiac conditions. Some have even been forced to drive “extremely long” distances to find a provider offering PET or SPECT, while physicians have referred patients to other organizations with access.
Last year, CMS sought feedback on potentially issuing separate payment for diagnostic pharmaceuticals. However, in the final rule issued in November, the agency opted to leave things alone and continue with the current packaging approach. Blackburn and colleagues said they appreciated CMS’ willingness to seek input from the field. An “overwhelming” majority of submitted comments (137/140) spoke in favor of issuing separate payment, as CMS did prior to 2008, the senators noted.
“However, the final CY 2024 OPPS rule did not change how diagnostic radiopharmaceuticals are reimbursed,” they wrote. “In the upcoming CY 2025 rulemaking on HOPPS, we urge CMS to address packaging of payment for diagnostic radiopharmaceuticals. This action is critical to ensure that Medicare beneficiaries have access to appropriate care in their communities.”
The letter comes after a key House committee advanced legislation to address this issue.
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.