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CMS Adjusts Nuclear Medicine Reimbursement Policy, Expanding Access to Life-Saving Scans

Imaging Technology

1, 2024 — The Centers for Medicare & Medicaid Services (CMS) have announced a significant adjustment to the Hospital Outpatient Prospective Payment System (HOPPS). However, under the previous reimbursement system, diagnostic radiopharmaceuticals were bundled as “supplies,” limiting access in several ways.

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Bipartisan bill aims to boost Medicare patients’ access to diagnostic imaging agents

Radiology Business

The Facilitating Innovative Nuclear Diagnostics Act of 2023 would eliminate barriers to nuclear medicine, supporters charged.

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New Study Shows Non-Radiologists Interpreting 28 Percent of Imaging for Medicare Patients

Diagnostic Imaging

While radiologists interpreted approximately 99 percent of all non-cardiac CT, MRI and nuclear medicine studies in hospital and emergency department settings for Medicare beneficiaries, new research shows significantly less radiologist review of cardiac imaging and office-based imaging.

Medicare 100
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Higher Medicaid-to-Medicare reimbursement ratios boost imaging use

AuntMinnie

Higher Medicaid-to-Medicare reimbursement ratios (MMRR) are linked to increased likelihood of Medicaid patients receiving CT, MR, ultrasound, and x-ray imaging, researchers have reported. Medicare reimbursement levels are set by individual states, and they vary across the U.S., Nuclear medicine 0.76 Ultrasound 0.85

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Medicare proposed rule again cuts radiology reimbursement in 2025

AuntMinnie

Centers for Medicare and Medicaid Services (CMS) has issued its proposal for payments in 2025 under the Physician Fee Schedule (PFS), and it contains an across-the-board 2.8% This reduction in payments continues a trend that has seen the Medicare fee schedule reduced by nearly 10% over the past 10 years. Radiology -3.8% -1.8% -2.8%

Medicare 105
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CMS proposes new coverage for PET imaging agents

AuntMinnie

Centers for Medicare and Medicaid Services (CMS) proposed a new reimbursement plan July 10 for diagnostic PET scans that would provide separate payments for radiopharmaceuticals, as well as an extra payment for hospitals when they use domestically produced technetium-99m (Tc-99m).

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CMS lifts limit on amyloid PET coverage

AuntMinnie

Centers for Medicare and Medicaid Services (CMS) announced on October 13 that it has lifted its coverage limit of one beta-amyloid PET scan per lifetime for patients with Alzheimer’s disease. Medicare coverage decisions for amyloid PET scans will now be made by local Medicare Administrative Contractors (MACs).