The Society of Nuclear Medicine and Molecular Imaging (SNMMI) and American College of Nuclear Medicine (ACNM) have submitted a letter to CMS in response to its 2019 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule, sharing both recommendations and concerns with the agency. The letter was signed by Satoshi Minoshima, MD, PhD, SNMMI president; Gary L. Dillehay, MD, chair of the SNMMI Coding & Reimbursement Committee; and Alan K. Klizke, MD, ACNM president.
The groups began on a positive note, thanking CMS for its decision to keep ambulatory payment classification (APC) groupings unchanged. “We appreciate that CMS has not proposed any changes,” the groups wrote. “We recommend that the current status be maintained.”
The letter’s focus then moved on to a CMS proposal that would remove three radiopharmaceuticals— C-11 choline, F-18 flutemetamol, and F-18 florbetaben—from pass-through status at the beginning of 2019. These are three “important” radiopharmaceuticals that are not interchangeable, the groups wrote, and rolling them into the nuclear medicine APC payment could limit patient access at many facilities across the country. SNMMI and ACNM both object to this proposal.
The groups also commented on three radiopharmaceuticals—Amyvid (florbetapir F18), Neuraceq (florbetaben F18) and Vizamyl (flutemetamol F18)—currently being evaluated in dementia trials. While Amyvid was removed from the pass-through list in January 2018, it went back on that list on Oct. 1. Now, CMS proposes removing the other two radiopharmaceuticals from pass-through status on Jan. 1, 2019.
“CMS’s policies should not favor one company’s radiopharmaceutical over others,” the groups wrote, noting that either all three should be on the pass-through list, they should be paid for with individual APCs or an amyloid APC group should be created.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.