NGS Agrees with SNMMI & Partners on PET/CT Reimbursement Changes

May 18, 2021

Earlier this week, SNMMI and our partners—the American College of Radiology, the American Society of Nuclear Cardiology, and the American College of Cardiology—heard good news from Stephen Boren, MD, medical director of National Government Services, Inc. (NGS). NGS is a Medicare Administrative Contractor (MAC). MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims.

In a letter dated May 11, believing that ensuring continued access to myocardial PET is critical, the societies advocated for 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,” they wrote.

The response was positive. "We are reviewing the PET scan pricings. We agree that PET CT should be reimbursed higher than PET alone. We will be making some changes in reimbursement," Dr. Boren stated.