CMS proposes reductions to Myocardial PET service payments

CMS proposes reductions to Myocardial PET service payments

par John R. Fischer, Staff Reporter | September 17, 2019
Cardiology Molecular Imaging
CMS is proposing cuts to technical component
payments for Myocardiac PET services as
high as 80 percent
Cuts to the technical component payments of Myocardial PET services may soon take place, reaching as high as 80 percent.

That is one of a number of revisions mentioned by the Centers for Medicare and Medicaid Services in its proposed Medicare Physician Fee Schedule for 2020. It is a response to updates made in the current procedural terminology (CPT) codes for reporting services and review of the direct practice expense inputs used to help calculate the technical component pay.

“The deep cuts are affecting the Medicare physician office and independent diagnostic testing facility (IDTF) centers that provide both myocardial metabolic and perfusion PET imaging,” Caitlin B. Kubler, SNMMI associate director of health policy and regulatory affairs, told HCB News.

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Motivating approval of the proposal is a decision made by CMS to assume a 90 percent utilization rate for PET cameras, which SNMMI argues needs to be reformed along with pricing information for other equipment. It claims, along with ACC, ACNM, ASNC, and CAA, that cuts as deep as these and made on such short notice are unsustainable and may lead to practice disruptions that affect patient access to PET services.

“One issue relates to CMS using the 90 percent utilization rate rather than the RUC-recommended 50 percent utilization rate for the PET equipment,” said Kubler. “SNMMI is asking its members to provide updated equipment invoices so that CMS can get the costs of all the equipment correct. CMS also chose not to accept the invoices that were already provided by the societies through the AMA RUC process for the hardware and software for myocardial blood flow PET. If the inputs are not correct, the relative values will not be calculated correctly.”

Invoices should be deidentified and refer to the following pieces of equipment:

• PET imaging camera, cardiac configuration (PET camera or refurbished/remanufactured PET cameras are all needed)
• PET generator infusion cart
• Myocardial blood flow hardware and software

They can be sent to ckubler@snmmi.org.

The public is also welcome to comment to CMS directly about the impact of the proposals, including on patient care.

SNMMI, the ACC, ACNM, ASNC and CAA are currently discussing their concerns with policymakers and have pledged to seek alternative approaches, including a delay period, for further analysis, should their task not be met within the constraints of the rulemaking timeline.

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