The Society of Nuclear Medicine and Molecular Imaging (SNMMI) has issued an early analysis of the 2027 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule.
"While the [HOPPS] proposal does not include the transition from mean unit cost (MUC) to average sales price (ASP) for separately paid radiopharmaceuticals that SNMMI has advocated for, it does include several positive code-level changes for nuclear medicine providers," the society said.
The U.S. Centers for Medicare and Medicaid Services (CMS) proposes increasing the packaging threshold for diagnostic radiopharmaceuticals from $655 to $665 per day for calendar year 2027, reflecting an inflation adjustment based on the Producer Price Index, SNMMI noted. Radiopharmaceuticals with per-day costs above the threshold would continue to receive separate payment; CMS estimates 32 diagnostic radiopharmaceuticals would qualify.
CMS also proposes retaining MUC as the payment methodology for established diagnostic radiopharmaceuticals in CY 2027, though it is encouraging voluntary ASP reporting from manufacturers and plans to publish an ASP reporting framework. For newly marketed diagnostic radiopharmaceuticals that lack sufficient claims data, CMS proposes using ASP plus 6% as the initial payment methodology.
In addition, the agency proposes reorganizing the Nuclear Medicine Ambulatory Payment Classification (APC) series, with proposed payment increases ranging from 9.51% to 67.85% across the five nuclear medicine APC levels, and formally recognizing Software-as- a-Medical-Service (SaMS) as a distinct technology category, potentially laying groundwork for future reimbursement of AI-enabled diagnostic technologies, SNMMI said.
The society is continuing to review the proposal, gathering member input, and preparing comments before the August 31 deadline.
