Nuclear medicine group discovers payment rate error with PET imaging agent

The Society of Nuclear Medicine & Molecular Imaging has discovered a reimbursement rate error for a long-used cancer imaging radiotracer and is working with federal authorities to remedy the issue.

SNMMI confirmed the problem last month, noting an inaccuracy in the Medicare Hospital Outpatient Prospective Payment System (HOPPS) published payment rate for Cerianna. The radiolabeled 18F-fluoroestradiol agent is used during PET imaging for estrogen receptor-positive lesions and as a complement to biopsy in patients with recurrent or metastatic breast cancer, SNMMI said Sunday.

The molecular imaging advocate also explained that it is working with both the manufacture of the radiotracer, Zionexa, and the Centers for Medicare & Medicaid Services to correct the problem.

According to the announcement, the correct rate should be $608.33 per millicurie instead of $0.752 per millicurie. CMS said any corrections will be retroactive to January 1, 2021.

“SNMMI will notify our members and update the Q&As when any corrections are implemented,” the announcement read. “Unfortunately, we are likely to see corrections at quarterly intervals, so the next is likely to be published in March for April 2021 or July 2021 implementation.”

Claims with a date of service from January 1, 2021, and after should use A9591 Fluoroestradiol F-18, diagnostic, 1 millicurie, according to SNMMI.

Problems with this issue should be sent to SNMMI at hpra@snmmi.org.