2009 Reimbursement Update for Imaging Centers paid under HOPPS

CMS recently issued its final rule for HOPPS, which goes into effect January 1, 2009. Use the link below to view a print friendly summary of the most important changes.

PET Reimbursement Rates for 2009

CPT Code	Description	2008 HOPPS	2009 HOPPS

78811 - 78813	PET Imaging	$1057.33	$1036.92
78814 - 78816	PET/CT Imaging	$1057.33	$1036.92
78459	Myocardial Imaging, PET, metabolic	$1400.98	$1156.87
78491 - 78492	Myocardial Imaging, PET, perfusion	$1400.98	$1156.87

For a full list of 2009 HOPPS rates for nuclear medicine procedures and radiopharmaceuticals, visit the SNM 2009 Final Hospital Rate APC Chart.

Packaging of Diagnostic Radiopharmaceuticals
For calendar year 2009, CMS will continue to package payment for all diagnostic radiopharmaceuticals into the procedure payment. All procedures billed MUST include the HCPCS code for the radiopharmaceutical used along with an accurate charge for that radiopharmaceutical. Even though CMS is packaging the payment for radiopharmaceuticals in with the technical component, it is important that appropriate charges for radiopharmaceuticals are represented as CMS will use this data for rate setting in the future.

New HCPCS Code for F-18 Sodium Fluoride
CMS has awarded a new HCPCS code for F-18 Sodium Fluoride, A9580. This HCPCS code should be used instead of A4641 when Sodium Fluoride bone scans are performed and Medicare is billed for a denial or when billing private insurance companies. Alert your provider about this code change. Important note: F-18 Sodium Fluoride bone scans are still NOT covered by CMS.

Cost-to-Charge Continues for Therapeutic Radiopharmaceuticals
Therapeutic radiopharmaceuticals and brachytherapy sources will continue to be reimbursed by the CCR methodology for calendar year 2009 as set forth by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. MIPPA extended the CCR methodology for 18 months beginning July 2008.

Packaging for Add-On Image Processing
CMS will continue to package add-on image processing services with the procedure CPT code. Packaged codes are; 76376, 76377, 78020, 78478, 78480 and 78496.

Disclaimer
This information provided by PETNET Solutions is based on published guidelines and on our experience, and is provided for general information only, as a service and at no charge to our customers. It is based on information found in published CMS National Coverage documents, but is not all-inclusive. We believe that the information set forth herein is generally accurate; however, we cannot provide assurance that it is complete, accurate or current. Always check with your local insurance carriers, as coverage may vary by region. The referring physician is responsible for pre-authorization and providing proof of medical necessity for any PET scan. PETNET Solutions and its representatives hereby expressly disclaim any and all liability for claims, including bodily injury or death, arising from any reliance on the information set forth herein.

Visit the SNM 2009 Final Changes to Policies & Payments for Hospital Outpatient Services (HOPPS) for a more detailed review.