Radiology advocates inching toward unified reimbursement plan for PET infection, inflammation exams
The American College of Radiology and other imaging leaders are collaborating on a path toward unified reimbursement for PET infection and inflammation exams.
Back in March, the Centers for Medicare & Medicaid Services reversed its long-standing decision to not reimburse for these exams, allowing local Medicare Administrative Contractors to determine whether to cover fluorodeoxyglucose (FDG) PET imaging of patients with infections and inflammation.
As it stands, none of the MACs have published official guidance on filing PET-CT claims for infection, the ACR said in a May 4 Bulletin article. The college is joining forces with the Society for Nuclear Medicine and Molecular Imaging, the American Society of Nuclear Cardiology, and the American College of Nuclear Medicine on joint teleconferences with each of the MACs to determine appropriate next steps.
These may include an outright payment of claims by MACs and new local coverage determinations, among other possibilities, the ACR explained.
Additionally, the aforementioned organizations are operating under the knowledge that more consistency is required between current LCDs across MACs and new LCD determination topics.
“The ACR’s Contractor Advisory Committee Network, the Commission on Nuclear Medicine and Molecular Imaging, and the Economics Committee on Nuclear Medicine are all monitoring progress of discussions with the individual MACs—with the intent of joining other stakeholders in a unified approach to establishing reimbursement for FDG PET for infection and inflammation,” Chair of the Economics Committee on Nuclear Medicine Benjamin L. Franc, MD, MS, MBA, wrote in the May 4 editorial.
Read the entire guest column here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.