Radiology advocates are pushing for PET imaging payment reform while bristling at questions around whether providers can appropriately perform the procedure in an office setting.
The Society of Nuclear Medicine & Molecular Imaging, American College of Radiology and others voiced their concerns in a recent letter to National Government Services, which processes Medicare payments. SNMMI et al. believe ensuring continued access to myocardial positron emission tomography is “critical.”
To do so, however, advocates want Medicare payment codes to reflect cost differences for performing varying types of exams, such as PET with and without CT.
“We strongly recommend that [National Government Services] determine appropriate rates for the myocardial PET procedures by recognizing that within the family of codes, there is a hierarchy in the complexity, time to perform and resource costs of the procedures,” the imaging groups wrote to Stephen Boren, MD, MBA, Medicare contractor medical director for the group, on May 11.
Imaging advocates recommended using the simplest, least pricey procedure—a single perfusion study—as a starting point, establishing other more complex exams relative to this reference. A single metabolic evaluation could cost 10% more than single perfusion, they suggested, while performing a CT scan concurrent with a PET procedure would cost 28% more to cover additional equipment.
National Government Services medical directors have recently questioned whether PET procedures can be appropriately performed in the physician office setting. SNMMI, ACR and others “strongly disagree” with this line of questioning. Concerns about where PET imaging is delivered, they added, should be addressed through the coverage determination process, not rate-setting methodology.
“Office-based procedures allow patients to receive services in a more timely manner and in a more accessible setting than is often available for hospital-based services,” they wrote. “Such access is particularly important during the COVID-19 public health emergency, when hospitals are often overwhelmed treating COVID patients and when non-COVID patients may be reluctant to obtain services at hospitals for fear of exposure.”
You can read the full letter—also signed by the American College of Cardiology and American Society of Nuclear Cardiology—here. ACR alerted its members about the issue in a news post shared May 13.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.