The Society of Nuclear Medicine and Molecular Imaging (SNMMI) has highlighted key points affecting nuclear medicine in the final rule for the 2026 Hospital Outpatient Prospective Payment System (OPPS).
The Centers for Medicare and Medicaid (CMS) released the final rule on November 21, and the SNMMI noted that it includes two new Healthcare Common Procedure Coding System (HCPCS) codes relevant to nuclear medicine:
HCPCS code C9176 will cover a $10 per-dose add-on for technitium-99m derived from domestically produced molybdenum-99.
HCPCS code A9616 has been assigned for reimbursement of gallium-68 gozetotide (Gozellix, Telix).
SNMMI said it was disappointed in the CMS’s decision to reassign CPT code 78803 covering SPECT scans to APC 5592. The move will result in a significant payment decrease of 57% and may limit patient access, affect patient care, and restrict hospitals from offering the test, the society said in a release.
Under the final rule, the CMS has raised the per-day diagnostic radiopharmaceutical cost threshold from $630 to $655, yet declined requests to freeze the threshold for two years, the SNMMI said. The CMS indicated it will monitor unintended pricing incentives, including manufacturers positioning prices just above the threshold, according to the organization.
In addition, the rule does not include the use of the average sale price and continues the use of the mean unit cost for diagnostic radiopharmaceuticals, the society noted.
"SNMMI is disappointed by this decision. We believe that paying for non-pass-through diagnostic radiopharmaceuticals using the arithmetic mean unit cost is inappropriate, as it does not reliably reflect the average price of a non-pass-through separately payable diagnostic radiopharmaceutical," it said.
