The Society of Nuclear Medicine and Molecular Imaging (SNMMI) and American College of Nuclear Medicine (ACNM) have submitted a letter to CMS in response to its 2019 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule, sharing recommendations and concerns with the agency.
The letter was signed by SNMMI president Satoshi Minoshima, MD, PhD, Gary L. Dillehay, MD, chair of the SNMMI Coding & Reimbursement Committee and ACNM president Alan K. Klizke, MD.
The organizations began their letter on a positive note, thanking CMS for its decision to keep ambulatory payment classification (APC) groupings unchanged.
Their focus then moved on to a CMS proposal that would remove three radiopharmaceuticals — C-11 choline, F-18 flutemetamol, and F-18 florbetaben — from pass-through status at the beginning of 2019, which SNMMI and ACNM both expressed objection to.
The three “important” radiopharmaceuticals are not interchangeable, the groups wrote, and rolling them into the nuclear medicine APC payment could limit patient access at many facilities across the country.
The groups also commented on three radiopharmaceuticals — Amyvid (florbetapir F18), Neuraceq (florbetaben F18) and Vizamyl (flutemetamol F18) — currently being evaluated in dementia trials. While Amyvid was removed from the pass-through list in January 2018, it was added back on the list on Oct. 1.
CMS is now proposing to remove the other two radiopharmaceuticals from pass-through status on Jan. 1, 2019.
“CMS’s policies should not favor one company’s radiopharmaceutical over others,” the groups wrote, noting that either all three should be on the pass-through list, should be paid for with individual APCs or an amyloid APC group should be created.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.