May 13, 2021

Provider Community Engages with Medicare Contractor about Payment for Myocardial PET Imaging

The American College of Radiology® (ACR®), Society of Nuclear Medicine and Molecular Imaging (SNMMI), American Society of Nuclear Cardiology (ASNC), and American College of Cardiology (ACC) sent a letter to National Government Services, Inc. (NGS) May 12 regarding payment for myocardial positron emission tomography (PET) codes. The associations assert it is critical that the Medicare payment rate for myocardial PET codes appropriately reflects the relative difference in the cost of performing different types of procedures (e.g., single vs. multiple studies, and with or without CT scans).

The associations urge NGS to consider retroactive implementation to January 2020 as current payment rates are inaccurate for new and revised codes. The letter references previous discussions with NGS and contends it should not use ambulatory surgical center rates to pay for physician office service, stating that those rates do not appropriately reflect the cost of performing a service in the office setting.

Questions about Medicare contracting matters should be directed to Alicia Blakey, ACR Senior Economic Policy Analyst.