CMS pulls about-face, revoking ‘unexpected’ new barriers to PET imaging payment
The Centers for Medicare & Medicaid Services has pulled an about-face this month, revoking “unexpected” new barriers to PET imaging it erected earlier this summer.
Imaging advocates had expressed excitement in March, anticipating the federal agency would lift longstanding restrictions around nuclear scans of inflammation and infection. However, CMS published nationally covered imaging indications in June, listing some imaging of osteomyelitis and “fever of unknown origin” as not covered.
The Society of Nuclear Medicine & Molecular Imaging said Tuesday that the feds appear to have reconsidered the controversial decision.
“Since June, SNMMI has been working with CMS to clarify, potentially reverse, and obtain more information for our members regarding this unanticipated and conflicting information in the transmittal. The result yielded great news,” the society said this week, with the agency revoking the noncovered imaging codes on Aug. 2.
SNMMI, the American College of Radiology and American Society of Nuclear Cardiology had been fighting to open up payment pathways for such PET imaging since 2008. With this latest determination, coverage decisions around such scans of bone infections or fevers will now fall to the local Medicare administrative contractor.
Advocates said the decision now opens a “path to reimbursement that ultimately will improve care for patients.” You can read more about the ruling in CMS Transmittal 10927 here.
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.