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Coding and Reimbursement

• Update on Kinevac Availability

  Sep 17, 2014 — Bracco Diagnostics Inc. announced that production is moving forward with targeted efforts for Kinevac commercial availability by the end of September.

• Upcoming Webinar: Oncologic PET Coding & Reimbursement

  Aug 20, 2014 — On September 23, 2014, Merlino Health Care Consulting Corp. will hold the webinar "Oncologic PET Coding & Reimbursement, Where Are We Today?"

• CMS Releases CY 2015 Hospital Outpatient Prospective Payment System Proposed Rule

  Jul 3, 2014 — On July 3, 2014, CMS released the CY 2015 HOPPS proposed rule.

• CMS Releases CY 2015 Medicare Physician Fee Schedule Proposed Rule

  Jul 3, 2014 — On July 3, 2014, CMS issued a proposed rule that would update payment policies and payment rates for services furnished under the MPFS on or after Jan. 1, 2015.

• CMS Releases Instructions Related to the NCD to End the Coverage with Evidence Development Requirement for FDG PET for Solid Tumors

  Jul 1, 2014 — CMS has released instructions to Medicare Administrative Contractors regarding the processing of claims pursuant to the June 11, 2013 final decision to end the coverage with evidence development (CED) requirement for certain FDG PET studies for solid tumors.

• CMS Releases Final Rule Concerning Direct Supervision

  May 8, 2014 — On May 7, 2014, CMS released the Final Rule for Part II Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction. This new rule finalized the previously proposed change of removing the term “direct" from the current requirement at § 482.53(b)(1).

• SNMMI Releases Q&A Regarding the Price Increase for Macroaggregated Albumin (MAA)

  Apr 23, 2014 — SNMMI has released a Coding Corner Q&A in response to the drastic price increase that went into effect on April 1, 2014 for macroaggregated albumin (MAA).

• CMS Releases Instructions on the NCD for Beta Amyloid PET in Dementia and Neurodegenerative Disease

  Feb 24, 2014 — CMS has released instructions to contractors related to its National Coverage Determination for Beta Amyloid PET in Dementia and Neurodegenerative Disease.

• SNMMI Submits Comments to CMS on CY 2014 HOPPS & MPFS Final Rules

  Jan 29, 2014 — On January 27, SNMMI submitted comments to CMS on the CY 2014 HOPPS & MPFS Final Rules.

• CMS Edits on the Ordering/Referring Providers in Medicare

  Nov 27, 2013 — If you order or refer items or services for Medicare beneficiaries and you do not have a Medicare enrollment record, you need to submit an enrollment application to Medicare.

• CMS Releases CY2014 Medicare Physician Fee Schedule Final Rule

  Nov 27, 2013 — On November 27, 2013, CMS finalized updates to payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule.

• CMS Releases CY2014 Hospital Outpatient Prospective Payment System Final Rule

  Nov 27, 2013 — On November 27, 2013, CMS issued the final Calendar Year 2014 HOPPS and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates final rule.

• Medicare Claims for FDG PET Studies with DOS

  Oct 9, 2013 — Effective June 11, 2013, CMS ended the coverage with evidence development (CED) requirement for F-18 fluorodeoxyglucose positron emission tomography (FDG PET) and FDG PET/CT for all oncologic indications contained in section 220.6.17 of the Medicare National Coverage Determinations (NCD) Manual.

• SNMMI Submits Comments to CMS Regarding CY 2014 Proposed Rules for HOPPS and MPFS

  Sep 6, 2013 — On Friday, September 6, SNMMI submitted comments to CMS on the CY 2014 Proposed Rules for the Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Physician Fee Schedule (MPFS).

• FDG Positron Emission Tomography for Solid Tumors and Myeloma: Data Collection Ends Under the National Oncologic PET Registry

  Jul 9, 2013 — Effective June 11, 2013, CMS ended the coverage with evidence development (CED) requirement for F-18 fluorodeoxyglucose positron emission tomography (FDG PET) and FDG PET/CT for all oncologic indications contained in section 220.6.17 of the Medicare National Coverage Determinations (NCD) Manual.

• CMS Releases CY2014 Hospital Outpatient Prospective Payment System Proposed Rule

  Jul 9, 2013 — More than 4,000 hospitals, including general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals, and cancer hospitals are paid under the OPPS. There are approximately 5,000 Medicare-participating ASCs paid under the ASC payment system.

• CMS Releases CY2014 Medicare Physician Fee Schedule Proposed Rule

  Jul 8, 2013 — On July 8, 2013, CMS issued a proposed rule that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2014.

• Updated: Complimentary Webinar for Positron Emission Tomography Imaging for Solid Tumors

  Jul 2, 2013 — SNMMI held a webinar to review and discuss the Centers for Medicare & Medicaid Services (CMS) final PET coverage decision to end coverage with evidence development (CED) for NOPR-covered FDG PET indications (CAG-00181R4), that was released on Tuesday, June 11th, 2013.

• CMS Releases Final Decision Memo for Positron Emission Tomography (FDG) for Solid Tumors

  Jun 11, 2013 — Today CMS posted a final decision to end the coverage with evidence development requirement for FDG PET for solid tumors (CAG-00181R4).

• AMA CPT Category III Codes Effective on July 1, 2013

  Jun 3, 2013 — The 2013-14 Current Procedural Terminology (CPT) electronic Category III file was released by the American Medical Association (AMA) on December 27, 2012.

• CMS Posts the Final Decision Memo of the PET NCA Reconsideration

  Mar 8, 2013 — On Thursday, March 7, the Centers for Medicare & Medicaid Services (CMS) posted a final decision memo for positron emission tomography (PET).

• CMS HCPCS Level II Codes Effective January 1, 2013

  Nov 27, 2012 — The 2013 Healthcare Common Procedure Coding System (HCPCS) electronic file has been posted with updated file information on the Centers for Medicare and Medicaid Services (CMS) web site.

• CMS Issues CY 2013 Physician Fee Schedule Final Rule

  Nov 2, 2012 — The Centers for Medicare & Medicaid Services (CMS) today issued a final rule for the Medicare Physician Fee Schedule.

• CMS Issues CY 2013 HOPPS Final Rule

  Nov 2, 2012 — The Centers for Medicare & Medicaid Services (CMS) finalized the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rule on November 1, 2012, updating Medicare payment policies and rates for hospital outpatient and ASC services beginning January 1, 2013.

• SNMMI Submits Comments on Proposed Hospital Outpatient Prospective Payment System Rules for CY 2013

  Sep 4, 2012 — SNMMI has submitted comments to the Centers for Medicare and Medicaid Services regarding the CY 2013 proposed rules for the Hospital Outpatient Prospective Payment System.

• SNMMI Submits Comments on Proposed Medicare Physician Fee Schedule Rules for CY 2013

  Sep 4, 2012 — SNMMI has submitted comments to the Centers for Medicare and Medicaid Services regarding the CY 2013 proposed rules for the Medicare Physician Fee Schedule.

• CMS Issues CY 2013 Hospital Outpatient Prospective Payment System Proposed Rule

  Jul 6, 2012 — The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) beginning Jan. 1, 2013.

• CMS Issues CY 2013 Physician Fee Schedule Proposed Rule

  Jul 6, 2012 — The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would increase payments to family physicians by approximately 7 percent and other practitioners providing primary care services between 3 and 5 percent.

• CMS Issues Proposed Rule for Reporting and Returning of Overpayments

  Feb 23, 2012 — CMS has issued a proposed rule implementing the requirements for reporting and returning overpayments set forth in the Affordable Care Act.

• CMS Issues New POS Guidance

  Feb 21, 2012 — The Centers for Medicare & Medicaid Services (CMS) has provided new Place of Service (POS) guidance in Change Request (CR) 7631 (Transmittal 2407) effective on April 1, 2012.

• Congress Passes 10 Month SGR Fix

  Feb 17, 2012 — Late Friday morning, the House of Representatives (293-132) and the Senate (60-36) passed the bipartisan agreement on legislation to extend the payroll tax holiday through the end of the year.

• HHS Announces Intent to Delay ICD-10 Compliance Date

  Feb 16, 2012 — Health and Human Services Secretary Kathleen G. Sebelius announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).

• New ICD-9-CM Volume 1, 2 Diagnosis Codes

  Jan 11, 2012 — The ICD-9-CM diagnosis code; 793.1 - Non specific (abnormal) findings on radiological and other examination of body structure; lung field, is frequently reported on FDG PET scan claims when PET is performed prior to biopsy for diagnosis of lung cancer in patients with lung masses, solitary pulmonary nodules and multiple pulmonary nodules.

• CMS HCPCS Level II Codes Effective January 1, 2012

  Jan 9, 2012 — The 2012 Healthcare Common Procedure Coding System (HCPCS) electronic file has been posted with updated file information on the Centers for Medicare and Medicaid Services (CMS) web site.

• Legislation Introduced to Address 2012 Medicare Accreditation Requirements

  Dec 2, 2011 — On November 2, Rep. James Renacci (R-OH) introduced HR 3328, which would provide a six-month grace period for Medicare imaging service suppliers to receive accreditation through an approved accrediting organization.

• 2012 Medicare Accreditation Requirements ARE YOU READY?

  Nov 27, 2011 — As the end of the year approaches, facilities that provide Advanced Diagnostic Imaging Services (ADI) should be aware of the January 1, 2012 accreditation mandate for nonhospital suppliers.

• CMS Issues CY 2012 HOPPS Final Rule

  Nov 3, 2011 — On November 1, 2011, The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period (final rule) that will update payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) beginning Jan. 1, 2012.

• CMS Issues CY 2012 Physician Fee Schedule Final Rule

  Nov 3, 2011 — On November 1, 2011, The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period that updates payment policies and rates for physicians and nonphysician practitioners (NPPs) for services paid under the Medicare Physician Fee Schedule (MPFS) in calendar year (CY) 2012.

• SNM Submits Comments on Proposed Medicare Physician Fee Schedule Rules for CY 2012

  Aug 26, 2011 — SNM has submitted comments to the Centers for Medicare and Medicaid Services regarding the CY 2012 proposed rules for the Medicare Physician Fee Schedule.

• SNM Submits Comments on Proposed Hospital Outpatient Prospective Payment Rules for CY 2012

  Aug 26, 2011 — SNM has submitted comments to the Centers for Medicare and Medicaid Services regarding the CY 2012 proposed rules for the Hospital Outpatient Prospective Payment System.

• CMS Issues CY 2012 Physician Fee Schedule Proposed Rule

  Jul 1, 2011 — The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update payment policies and rates for physicians and non-physician practitioners for services paid under the Medicare Physician Fee Schedule (MPFS) in calendar year (CY) 2012. More than 1 million providers of health services to Medicare beneficiaries are paid under the MPFS.

• CMS Issues CY 2012 Hospital Outpatient Prospective Payment System Proposed Rule

  Jul 1, 2011 — The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) beginning Jan. 1, 2012.

• SNM Comments on Palmetto’s Policy Change for Rubidium, Rb-82

  Jun 22, 2011 — On Monday June 20th, the Society of Nuclear Medicine signed a joint statement sent to Palmetto GBA, inquiring about their recently revised reimbursement policy for the radiopharmaceutical, Rb82 rubidium, diagnostic, per study dose, up to 60 millicuries.

• MedPAC Report Urges Prior Authorization for Advanced Imaging Services

  Jun 16, 2011 — The Medicare Payment Advisory Commission (MedPAC) has issued its June report to Congress and in the report, urges Medicare to implement a prior authorization program for clinicians who order more advanced imaging studies than their peers.

• Accreditation Claims Processing Update - May 2011

  May 27, 2011 — The Medicare Payment Advisory Commission (MedPAC) has issued its June report to Congress and in the report, urges Medicare to implement a prior authorization program for clinicians who order more advanced imaging studies than their peers.

• NOPR Update: Medicare Advantage Plans Request Recoupment for Inappropriately Paid NOPR Claims Retroactive to April 3, 2009

  Apr 25, 2011 — It is our understanding that some Medicare Advantage (MA) plans have sought recoupment of payments to providers for FDG-PET scans performed as part of NOPR. NOPR has sought clarification on this issue from CMS.

• CMS to Correct National Correct Coding Errors

  Feb 18, 2011 — Recently, a number of members reached out to SNM regarding a sudden rejection of Medicare claims for nuclear medicine therapy and diagnostic procedures with dates of service beginning January 1, 2011.

• CMS Issues Instructions for Reprocessing Claims Affected by the Affordable Care Act and 2010 Medicare Physician Fee Schedule Changes

  Feb 9, 2011 — On February 8, 2011, CMS issued instructions for reprocessing claims affected by the Affordable Care Act and 2010 Medicare Physician Fee Schedule changes.

• SNM Posts Summary of the CY 2011 Medicare Physician Fee Schedule Final Rule

  Jan 5, 2011 — On November 2, 2010, the Centers for Medicare & Medicaid Services posted a final rule for Medicare payments in the physician fee schedule (MPFS) for calendar year CY 2011.

• SNM Posts Comments for the CY 2011 Hospital Prospective Payment System Final Rule

  Jan 5, 2011 — SNM has submitted comments to the Centers for Medicare & Medicaid Services regarding the CY 2011 final rules for the Hospital Outpatient Prospective Payment System (HOPPS).

• New CMS Specialty Code for Advanced Diagnostic Imaging Accreditation

  Dec 17, 2010 — The Centers for Medicare & Medicaid Services has made some recent clarifications to information previously published relating to use of specialty code 95 for Advanced Diagnostic Imaging (ADI).

• New CMS Specialty Code for Advanced Diagnostic Imaging Services

  Nov 24, 2010 — Effective April 1, 2011, CMS (the Centers for Medicare & Medicaid Services) will require that a new specialty code for advanced diagnostic imaging services be reported.

• SNM Posts Summary of 2011 CMS Final Rule Changes for HOPPS

  Nov 24, 2010 — A summary of the Centers for Medicare & Medicaid Services (CMS) final rules for 2011 that affect nuclear medicine and PET has been posted on the SNM website.

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