PET biomarker reimbursement guidelines have been changing frequently as new indications are approved and rates are updated.  Cardinal Health understands local and national standards for reimbursement. We understand the complexities of and comply with the reimbursement policies, procedures and coding requirements of payer programs related to reimbursement for the PET services performed. PET Foundations^SM; provides reimbursement information and tools to help you educate your referring physicians.

• The In Touch™ Program provides direct telephone support via a toll free number for fast, personalized assistance with general or local PET questions related to billing, coding or reimbursement and is available to our contracted customers.  To learn more about this program, contact one of our Clinical & Market Development Specialists to schedule a session.

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Reimbursement Guides

• PET Reimbursement Guide
• Medicare Coverage Criteria for FDG-PET for Alzheimer's Disease
• PET Reimbursement Guide - for ¹⁸NaF

PET/CT Physician Order Forms

• Oncology
• Neurology
• Cardiology

HOPPS¹

Under the Hospital Outpatient Prospective Payment System (HOPPS), effective January 1, 2008 (and this is expected to continue in 2011), 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.

MPFS²

Under the Medicare Physician Fee Schedule (MPFS) diagnostic radiopharmaceuticals continue to be paid separately and this is expected to continue in 2011.

Resources

• Society of Nuclear Medicine’s listing of all the current CPT/HCPCS codes used in Nuclear Medicine, their descriptions, APC assignment and payment rates under HOPPS. http://interactive.snm.org/index.cfm?PageID=1981&RPID=43
• Society of Nuclear Medicine’s practice management spreadsheets applicable to the physician office/clinic setting under the MPFS http://interactive.snm.org/index.cfm?PageID=1982&RPID=941

References

1. CMS Hospital Outpatient Prospective Payment System
   http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp
2. CMS Medicare Physician Fee Schedule
   http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/list.asp