PET Perfusion Reimbursement to Increase in 2010

November 18, 2009 – The Centers for Medicaid and Medicare Services (CMS) recently announced it will increase the reimbursement for positron emission tomography (PET) cardiac procedures in 2010.

The final published rule maintains the assignment of all cardiac PET CPT codes to APC 0307 – PET myocardial perfusion imaging, with an increase in the payment for APC 0307 from $1,156.87 in 2009 to $1,432.87 in 2010 – a 24 percent increase from 2009. CMS’s Hospital Outpatient Prospective Payment System (HOPPS) and the 2010 payment rates for procedures continue to package payment for PET radiopharmaceuticals with payment for the imaging procedure (i.e. the nuclear medicine procedure ambulatory payment classifications (APC) payment rate).

The increased reimbursement makes it more economically feasible for groups to adopt cardiac PET, said officials at Bracco Diagnostics Inc., which supplies PET radiotracers. The company said the increase, combined with the current worldwide shortage of the Mo-99 isotope used in SPECT imaging, have created more compelling reasons for physicians and hospitals to implement PET for myocardial perfusion imaging.

PET also offers unique advantages that can be especially beneficial for difficult-to-image patients, including females, those who are obese or require pharmacologic stress testing, and patients with multivessel disease or who have had an equivocal SPECT MPI study.

The final rule established by CMS will be effective for services on or after Jan. 1, 2010.

For more information: www.braccoimaging.com, www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp#TopOfPage