The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is breathing a collective sigh of relief after this week's release by the U.S. Centers for Medicare and Medicaid Services (CMS) of its 2020 physician and hospital outpatient reimbursement schedules.
CMS' final rule for the 2020 Medicare Physician Fee Schedule (MPFS) and 2020 Hospital Outpatient Prospective Payment System (HOPPS) final rule maintains current pricing into next year. This is a change from the earlier proposal, which would have reduced payments by as much as 80%. In addition, instead of a 157% decrease in reimbursement for some SPECT and SPECT/CT studies, CMS will increase reimbursement by 3.5%.
Other details in the MPFS final rule include the following:
- CMS accepted the 50% equipment utilization rate, rather than 90% utilization.
- CMS agreed with the majority of the invoices submitted by SNMMI for PET, PET/CT, and SPECT/CT and all updated equipment rates.
- CMS agreed with all submitted SPECT/CT invoices and updated all equipment cost rates from $464,428 to $703,443. CMS also will fully implement these rates, rather than implement them gradually.
Regarding the HOPPS final rule, the CMS accepted the jointly prepared new technology application for alternative placements for the new PET and PET/CT current procedural terminology (CPT) codes. The agency also agreed to temporarily place these services in new technology categories while it collects charge and cost data from hospitals for future rule placements.
Finally, CMS made no changes regarding implementation of the mandate requiring clinicians to consult appropriate use criteria through a qualified clinical decision-support process when ordering advanced imaging, such as SPECT/PET myocardial perfusion imaging, CT, and MRI.
SNMMI plans to hold a webinar on December 5 to review the new codes and the payment rates. Further details on the event are pending.
