PET proponents are rejoicing at the news that the Centers for Medicare and Medicaid Services (CMS) will retain 2002 outpatient reimbursement rates for FDG-PET procedures next year. CMS had been proposing a 42% cut in the rate for oncology PET procedures and a 9% cut in cardiac PET payments for its 2003 outpatient payment schedule.
On October 31, the agency posted a final rule for its Hospital Outpatient Prospective Payment System/ambulatory payment classification (HOPPS/APC), which included coverage for PET procedures at $1,375 (CPT codes G0210-G0234), and payment for FDG at a rate of $392.64 per 4-40m/Ci/ml dose. The rule will go into effect on January 1, 2003, and the agency is taking comment for 60 days.
CMS earlier this year proposed cutting the rate for oncology PET to $971.53 and for cardiac PET to $870.11. It would have paid for FDG at a rate of $475 a dose.
"We’re pleased that CMS re-examined the issue and the concerns that (the nuclear medicine) community had about the quality of the data CMS collected," said William Uffelman, general counsel and director of public affairs for the Society of Nuclear Medicine (SNM) in Reston, VA. "Continuation of the $1,375 rate for the procedure and reimbursement for FDG will allow facilities to offer PET and make business decisions around a stable rate structure."
During the previous comment period for the rule, advocates for the technology pointed out that hospitals were still learning how to report PET procedures, which skewed PET costs downward. In addition, the data that CMS was using to calculate PET reimbursement was derived from both dedicated PET systems and gamma cameras retrofitted with coincidence detection PET modules, rather than solely on dedicated PET units (most gamma camera PET isn’t eligible for Medicare reimbursement).
In the rule, CMS acknowledged the latter problem, and stated that until PET data reflects the predominant use of dedicated scanners, CMS will continue to pay for FDG-PET under new technology code APC 714 until it can review further data for the 2004 rule.
Even if PET technology users would eventually like higher reimbursement rates for the procedure, it’s important that the existing rate has been maintained, according to Uffelman.
"If the rate fluctuates from year to year, facilities can’t meet financial commitments," he said. "The PET community can work with this rate -- the real key is stability."
By Kate Madden Yee
AuntMinnie.com contributing writer
November 8, 2002
Related Reading
PET advocates urge CMS to rethink proposed reimbursement rates, September 30, 2002
U.S. Senate leaders reach deal on Medicare provider payment changes, September 27, 2002
Decrease proposed for 2003 PET APC reimbursement, August 12, 2002
Hospitals say Medicare rate hike falls short, May 10, 2002
New HOPPS rates bring PET reimbursement hike, March 4, 2002
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