Reimbursement News
2009 Reimbursement Update for Imaging Centers paid under PFS
CMS recently issued its 2009 Final Medicare Physician Fee Schedule (MPFS) Rule. Use the link below to view a print friendly summary of the most important changes.
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2009 Reimbursement Update for Imaging Centers paid under HOPPS
CMS recently issued its final rule for HOPPS, which goes into effect January 1, 2009. Use the link below to view a print friendly summary of the most important changes.
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2009 Billing Update for 18F Sodium Fluoride PET Bone Imaging
Last year in 2008 the definitions of CTP codes 78811-78816 for PET and PET•CT imaging were changed to remove the word “tumor”, and effective January 1, 2009, a new radiopharmaceutical code A9580 was established for 18F Sodium Fluoride.
18F Sodium Fluoride PET bone scanning is not covered by Medicare, but these are important billing changes when billing Medicare for non-covered services, or when billing third party payers. On January 2, 2009 the Society of Nuclear Medicine updated their previous opinion about 18F Sodium Fluoride PET bone scanning.
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Proposed Decision Memo for FDG PET for Solid Tumors
On January 5 2009, CMS posted a proposal for public comment that expands the coverage of several PET indications. This is largely based on the impressive change-in-management results from the National Oncologic PET Registry (NOPR). Currently, imaging centers and hospitals that are registered to participate in the NOPR are getting reimbursed for several PET indications that are not officially covered by Medicare.
This new CMS coverage document proposes that indications currently covered with evidence development (CED) through the NOPR be officially covered by Medicare for “initial treatment strategy” (formerly “diagnosis” and “staging”), with some exceptions such as prostate cancer. These same indications will only be covered for “subsequent treatment strategy” scans (formerly “restaging” and “monitoring”) through the continued CED. The currently approved indications remain covered; however, CMS proposes to change the existing language of diagnosis,staging, restaging and monitoring of therapy to initial treatment strategy and subsequent treatment strategy as well.
CMS is looking for data-driven answers to some very specific questions in the submitted comments, please see the proposed decision memo to review their questions. For a detailed comparison of the current and the proposed PET coverage framework, click on FULL STORY below.
View both the proposed decision memo and submit comments on the CMS website
Read more details in the Society of Nuclear Medicine press release
Read industry opinions in the Diagnostic Imaging on-line article
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Patient Advocacy
Month of January designated Cervical Cancer Awareness Month
January has been designated Cervical Cancer Awareness Month to raise awareness of the importance of early detection and treatment of cervical cancer. Uterine cervical carcinoma is estimated to be the second most frequently diagnosed cancer in women and is a common cause of death in the female population. The American Cancer Society estimated 11,070 new cases of invasive cervical cancer among women in the U.S. in 2008 and approximately 3,870 deaths among women as a result of cervical cancer.
Medicare has approved PET or PET•CT imaging for staging of newly diagnosed cervical cancer subsequent to negative conventional imaging.
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