SNM: DRA could slash PET, PET/CT reimbursement 70%

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The Access to Medical Imaging Coalition and SNM recently joined together to appeal to Congress to reconsider the cuts that are part of the federal Deficit Reduction Act of 2005. SNM placing payment caps to physicians' offices with imaging equipment which is set to start Jan. 1, 2007.

"The proposed reductions for diagnostic imaging reimbursement fail to recognize the fundamental differences between the costs associated with providing imaging services in a physician's office as opposed to a hospital outpatient department," said SNM President Martin P. Sandler. "The final Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System rules, released earlier this month, give a true sense of the severity of the cuts that will affect our members. SNM opposes this legislation and is working as a member of AMIC to reverse or halt this implementation until the full impact of the cuts can be determined," he said.

Under DRA, reimbursement for Medicare beneficiaries who use outpatient imaging services at centers not affiliated with hospitals will be linked to HOPPS rather than MPFS in instances where the payment rate for the technical component of the PFS is greater than that of the HOPPS rate. The MPFS was developed to reflect the cost of imaging services based on factors that are specific for freestanding diagnostic imaging facilities, according to an SNM release.

"With DRA's implementation, the dramatic difference between reimbursement rates under MPFS and HOPPS could reduce payments for PET and PET/CT scans by as much as 70 percent," said Gary L. Dillehay, chair of SNM's Coding and Reimbursement Committee. In addition, other nuclear medicine procedures - particularly cardiac and SPECT ones - will also be impacted, he said. "These payment caps written into the 2005 DRA are for reimbursement only on the technical - not the professional or pharmaceutical - component of imaging procedures performed in freestanding and in-office outpatient imaging facilities," he said.

Dillehay emphasized that DRA provisions do not affect the payment methodology or rates for drugs or radiopharmaceuticals used with imaging procedures.

As a member of the Access to Medical Imaging Coalition, SNM has joined other groups such as the Academy of Molecular Imaging, American College of Radiology, American Association of Physicists in Medicine, Alzheimer's Disease International, Institute for Molecular Technology, Lung Cancer Alliance, National Ovarian Cancer Coalition and Society of Interventional Radiology.