On Jan 1, 2020, NETSPOT (Ga68 DotaTate PET/CT) will no longer be paid for separately and while Medicare will still cover the scan (as appropriate) at the highest bundle level (~$1,400), this reimbursement will be less than the cost of the imaging agent (~$3,200). After the 3-year period when Medicare paid for these agents separately expired, 2/3 of the facilities offering scans with these new agents stopped providing the scan. Then innovation happened - several imaging agents have come to market that cost thousands of dollars. After 3 years the imaging agent is no longer billed separately and is added to one of the various bundles with the idea that some agents would be cheaper and some more expensive and it would average out. The provider would be paid the average selling price + 6% for the imaging agent. To accommodate new imaging agents, Medicare allowed a provider (hospital) to bill new agents outside the bundle and be paid for separately as a drug for a period of 3 calendar years. The most expensive bundle is ~ $1,400 (there are some regional adjustments). These bundles allowed a provider to bill for all PET imaging in a simplified manner. The simplification reduced an infinite combination of supplies and tracers to a few PET bundles based on tracer cost. In 2008, Medicare/CMS simplified how CMS paid for PET Imaging. This bill is not looking at broader medical payment, billing or cost issues. 3772), which many in the nuclear medicine community are working on to help improve, will impact Medicare payments for imaging only. The Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019 (H.R. This webpage provides more information on how this will impact NET patients and providers along with a tool for those that are interested in taking action. On October 18, 2019, an opinion piece that NorCal CarciNET Community’s Josh Mailman opinion article ( “CMS policy shouldn't penalize those with rare disease”) was published by The Hill, The opinion piece highlighted the challenges with the current method that Medicare/CMS use to pay for radiopharmaceuticals.
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