On July 14 CMS released the Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System Proposed Rules.
The OPPS proposed rule did not change the payment methodology for separately paid radiopharmaceuticals. We will continue to work to urge CMS to use “average sales price” rather than “mean unit cost.”
The threshold for separately paid radiopharmaceuticals increased from greater than $630 to greater than $655.
Add on payment of $10 for products using domestically produced Molly 99, to encourage domestic production.
All PET and PET/CT codes remain at contractor price, consistent with SNMMI advocacy.
Software as a Service Reimbursement: CMS is requesting feedback on how to price services using software as a service model.