The U.S. Centers for Medicare and Medicaid Services (CMS) has announced new payment rates for hospital outpatient services that include sharp reductions in payments for cardiac and oncology PET studies.
CMS on November 1 issued a final rule setting rates under its Hospital Outpatient Prospective Payment System (HOPPS). Under the rule, Medicare reimbursement for multiple-scan heart imaging PET studies (current procedure terminology [CPT] code 78492) will fall 71%, to $731.24, compared to $2,484.88 in 2006.
Oncology PET studies will get hit as well, although not as hard. Tumor imaging with PET from skull base to midthigh (CPT 78812) will have a new reimbursement level of $855.43, down 26% compared with $1,150 under 2006 HOPPS rates. Tumor imaging with PET/CT from skull base to midthigh (CPT 78815) will be paid at the rate of $950, down 24% compared with $1,250 in 2006.
Reimbursement for other molecular imaging procedures, such as nuclear medicine bone scans and cardiac SPECT studies, were either unchanged or saw slight increases under the HOPPS final rule.
The final rule implements sharp cuts in reimbursement that CMS proposed earlier this year. The cuts are likely to be particularly damaging due to the Deficit Reduction Act (DRA) of 2005, which mandates that imaging services be reimbursed at the lower of either the HOPPS rate or the Medicare Physician Fee Schedule (MPFS).
The new reimbursement levels for nonmyocardial PET represent the agency's collection of five years of data since the modality was assigned a reimbursement level using a New Technology Ambulatory Payment Classification (APC) code in August 2000. CMS now believes it has sufficient data to assign a clinically appropriate APC code for calendar-year (CY) 2007, the agency said.
"Based on analysis of the Medicare claims data, the median costs of nonmyocardial PET scans have ranged between $852 and $924 for claims submitted from CY 2002 through CY 2005," the agency said. "However, our payment rates have been significantly higher than the median costs throughout this same period."
By AuntMinnie.com staff writers
November 6, 2006
Related Reading
DRA threatens to throttle PET, October 13, 2006
PET market continues double-digit growth, June 9, 2006
Rubidium-based PET may finally get its due, February 23, 2006
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