September 21, 2005
On September 15, the Society of Nuclear Medicine and the Nuclear Medicine APC Task Force submitted comments to Mark McCellan, MD, PhD, administrator of the Centers for Medicare & Medicaid Services (CMS), on the proposed changes to the Hospital Outpatient Prospective Payment System.
Some of the highlights in both of these comments penned by Gary Dillehay, MD, chair of Coding & Reimbursement Committee and Kenneth A. McKusick, MD, chair, Nuclear Medicine APC Task Force, include:
The Nuclear Medicine APC Task Force will request a meeting with CMS to discuss payments for radiopharmaceuticals and handling fees in 2006.
In separate comments, the SNM addressed in more detail the issue of appropriate reimbursement for diagnostic CT when performed in conjunction with PET/CT and provided additional data and support for the Task Force's comments on radiopharmaceutical reimbursement issues. The SNM pointed out that "there are added costs for acquiring the diagnostic CT data such as for the contrast agent and appropriate nursing and technical personnel. These were not assumed for any previous cost determination, such as for the PEAC, for doing a PET/CT. These costs should be reflected in any new payment scheme proposed. Further, there should be consideration given on how to properly code for a diagnostic CT when performed as single acquisition with a PET/CT." Additionally, the SNM addressed several individual nuclear medicine CPT codes, such as inappropriately moving 78700 to a Level 3 ultrasound APC. The SNM made specific recommendations for appropriate placement and status indicator changes for some nuclear medicine procedures and related drugs and radiopharmaceuticals.
Links to these comments, for your detailed review, are in the Related Items box below.