PET reimbursement guidelines have been
changing frequently as new indications
are approved and rates are updated. DMS
strives to keep current on these changes
and to update our customers as well, sharing
helpful tools to assist in
their
practices
such as the PET
Reimbursement Guide and a sample FDG
PET Scan Prescription Pad.
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National Oncologic
PET Registry: |
| NOPR |
The National Oncologic
PET Registry - NOPR (www.cancerpetregistry.org) was
developed in response to the Centers for Medicare and
Medicaid Services (CMS) proposal to expand coverage for
PET with F-18 fluorodeoxyglucose (FDG) for oncology indications
not otherwise eligible for Medicare reimbursement. Medicare
reimbursement for oncology indications covered under
the NOPR can now be obtained by facilities that have
registered with the NOPR to participate and fulfill NOPR
program requirements for data submission.
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NOTE: Under the Hospital Outpatient Prospective Payment System (HOPPS), effective January 1, 2008, CMS will package the payment for all diagnostic radiopharmaceuticals into
the payment for the scan. Although payment for diagnostic radiopharmaceuticals will be packaged into the payment for the scan, CMS will require providers to bill for the diagnostic radiopharmaceutical
used in conjunction with the nuclear medicine procedure performed. Moreover, CMS will return to providers any claim for a nuclear medicine study that does not also contain a HCPCS code and charge for
a diagnostic radiopharmaceutical. For further details please click here.
DMS representatives understand local
and national standards for reimbursement.
They work with customers to develop
the appropriate coding and language
to maximize reimbursement. DMS can
provide a particularly thorough
reimbursement analysis program to
PET customers.
For example, because Alzheimer's
Disease coverage is very specific,
DMS makes available a coverage
criteria guide and a checklist/scan
order form to help you educate
and work with your referring physicians.
DMS also partners with others in
providing up-to-date reimbursement
information. For more information
visit: The
Society of Nuclear Medicine.
Note: The Society
of Nuclear Medicine has published
very useful spreadsheets (available
in both .pdf and Excel formats)
listing all the CPT/HCPCS codes
used in Nuclear Medicine, their
descriptions, APC assignment and
payment rates under HOPPS 2006
compared to HOPPS 2005. Find these
spreadsheets at: http://interactive.snm.org/index.cfm?PageID=1981&RPID=43.
Spreadsheets applicable to the physician office/clinic setting may be
found at: http://interactive.snm.org/index.cfm?PageID=1982&RPID=941
Also note: The March, 2004 Journal of Nuclear
Medicine Technology offers a comprehensive article on FDG
PET Reimbursement from Cardinal Health's Jim Bietendorf: FDG
PET Reimbursement. Bietendorf
J. J Nucl Med Technol. 2004 Mar; 32(1):33-8 Free
to Journal of Nuclear Medicine Technology Subscribers.
See our Medicare Documents Online webpage
for additional Medicare resources available via the internet. |
