SNMMI, the Medical Imaging and Technology Alliance (MITA), and the Council on Radionuclides and Radiopharmaceuticals (CORAR) teamed with Curium, GE Healthcare, Avid Pharmaceuticals/Eli Lilly, and other interested parties to urge CMS to follow current guidelines.
The Medicare Modernization Act of 2003 designated all therapeutic and diagnostic radiopharmaceuticals as drugs, but CMS continues to classify the tracers as supplies. By doing so, the radiopharmaceuticals are reimbursed under ambulatory payment classifications (APCs) in the Medicare Hospital Outpatient Prospective Payment System (OPPS).
Because of this practice, the cost of some diagnostic radiopharmaceuticals exceeds the total APC procedural payment, the groups allege, which discourages hospitals from using newer tracers and investment in research and development.
A bill could soon be introduced in Congress to rectify the situation, according to the SNMMI.
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