CMS Decision on PET Scan Reimbursements

Posted by Rachel Masey

Thu, Jul 18, 2013 @ 12:12 PM

The following commentary explains some important changes with the CMS decision on PET scan reimbursements:

PET Scanner

Centers for Medicare and Medicaid (CMS) did not offer blanket coverage for all solid body tumors for PET scans, and hence sites had a difficult time being reimbursed for studies that were clinically appropriate, yet not covered.  In an effort to obtain data on all kinds of tumors, the NOPR (pronounced “no-par”), or the National Oncologic PET Registry was developed in about 2006.  As long as sites participated in NOPR, they could be reimbursed for the PET studies for which there was no official code (see attachment).  As a condition of NOPR, sites had to submit pre-scan data, post-scan data, and physician interpretation forms all within timeframes set by the Registry. Once all scans were complete and the paperwork was submitted, the site was eligible for reimbursement. As of June 2013, CMS has approved coverage for all solid tumors based on the NOPR data acquired.  Additionally, a “PET” scan is officially defined by CMS as a stand-alone PET, a PET/CT or a PET/MR scan. This is HUGE win for all sites participating in the NOPR paperwork nightmare of reimbursement.

GREAT NEWS:

  1. Sites can now get paid in a timely fashion for oncologic PET scans.
  2. CMS has officially defined a “PET” scan to include PET/CT and PET/MR.
  3. There has been NO CHANGE for cardiac PET (covered) or F-18 bone scan indications (still NOPR).

 

To learn more, check out these helpful NOPR articles

 

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