Reimbursement Issues

ACNM, in close collaboration with SNMMI, reports on and analyzes coding and reimbursement updates from the US government that impact the field of nuclear medicine and molecular imaging.

  • CMS regulations
  • Recognition of and reimbursement for nuclear imaging procedures by Medicare and other third-party payers
  • Recognition of and reimbursement for nuclear medicine-related drugs and radiopharmaceuticals
  • Relative value scales and physician reimbursement in general
  • News articles and press releases directly related to reimbursement and/or CMS

When reading materials about reimbursement and coding, always make sure to read the date and type. Reimbursement and coding information modifications by the United States government are extremely frequent, so always double check the respective agencies' websites to ensure you have the most current data.

Latest News

MAC Update on Retirement of NCD for FDG PET Infection & Inflammation

Mar 11, 2021 — Subsequent to the retirement by CMS of the NCD for the non-coverage of FDG PET for infection and inflammation, in the absence of a MAC Local Coverage Determination, National Coverage Determination, or CMS Manual Instruction, reasonable and necessary guidelines apply. 

CMS Retires National Non-Coverage Policy for FDG PET Infection and Inflammation
Mar 1, 2021 — Since 2008, CMS has not covered PET for imaging of infection and inflammation. Now that has changed.

CMS Confirms HOPPS Payment Rate Error for CERIANNA™ (Fluoroestradiol F-18) Injection
Feb 22, 2021 — SNMMI has been working with Zionexa to seek proper Medicare reimbursement for Cerianna, radiolabeled 18F-fluoroestradiol indicated for use with positron emission tomography (PET) imaging for detection of estrogen receptor–positive lesions as an adjunct to biopsy in patients with recurrent or metastatic breast cancer. As of January 2021, the HOPPS published rate for this product is incorrect.

Detectnet™ (Copper Cu-64 Dotatate Injection) Gets a New HCPCS Level II Code
Feb 10, 2021 — Recently, the Centers of Medicare and Medicare and Medicaid Services (CMS) granted Detectnet™ a HCPCS Level II Code, A9592 (copper cu-64, dotatate, diagnostic, 1 millicurie), effective April 1, 2021.

President Signs 2021 Appropriations Act, Supplements Physician Reimbursement, Provides COVID-19 Relief
December 27, 2020 —Today, President Trump signed the Coronavirus Response and Relief Supplemental Consolidated Appropriations Act of 2021 into law. The House (359 to 53) and Senate (91 to 7) passed the legislation by a vote of 359 to 53 on December 22.

Final 2021 MPFS Rule Fails to Provide Relief, SNMMI and Coalition Lobby Congress to Protect Physician Reimbursement and Access to Care
December 2, 2020 —Yesterday evening, December 1, the Centers for Medicare and Medicaid Services (CMS) released the calendar year 2021 Medicare Physician Fee Schedule (MPFS) final rule.

SNMMI and Coalition Support Bill Waiving Budget Neutrality, Increasing Proposed Physician Reimbursement for 2021
Nov 11, 2020 — Today, SNMMI and a coalition consisting of 73 medical societies sent a letter to Congress in support of H.R. 8702, a bill to halt pending Medicare payment cuts resulting from the planned evaluation and management (E/M) code changes slated for implementation on January 1, 2021.

SNMMI and Partners Ask Congress to Waive Budget Neutrality for MPFS
Oct 13, 2020 — On Friday, SNMMI and several medical societies sent a joint letter asking Congress to waive budget neutrality for the relative value unit increases in the CY 2021 Medicare Physician Fee Schedule. The CMS Proposed CY 2021 MPFS Rule increased payment rates for evaluation and management codes; however, because of budget neutrality imposed by Congress, increases would lead to huge deficits other payment rates.

SNMMI Comments on 2021 MPFS Proposed Rule

Sep 30, 2020 — On Monday, August 3, the Centers for Medicare and Medicaid Services (CMS) released the calendar year 2021 Medicare Physician Fee Schedule (MPFS) proposed rule. Though SNMMI agrees with the adoption of the new evaluation and management (E/M) coding structure recommended by the American Medical Association (AMA), this will result in significant payment reductions to nuclear medicine (~8%) and radiology (~11%) services unless the government removes the budget neutrality requirements.