As you all may know, diagnostic radiopharmaceuticals are afforded a 2 – 3-year transitional pass-through period during which they are paid separately by Original Medicare in the hospital setting. After this transitional pass-through period expires, diagnostic radiopharmaceutical payments become packaged in with the procedure payment in a manner that greatly reduces the reimbursement to the hospital. The transitional pass-through period for a number of diagnostic radiopharmaceuticals including Axumin® (fluciclovine F 18) injection1 is set to expire on January 1, 2020. In many states, hospitals are the primary, and sometimes the only, facilities that perform PET scanning. When transitional pass-through ends, hospitals are left with the choice of performing every scan at a significant loss or discontinuing the service that patients and physicians have come to rely on.
A bill has recently been introduced in the U.S. House of Representatives – H.R. 3772 –to preserve Medicare beneficiary access to diagnostic radiopharmaceuticals under the Medicare hospital outpatient prospective payment system. Members of Congress are always interested in hearing directly from their constituents, particularly those that are caring for these patients.
Please consider reaching out to your members of Congress in support of H.R. 3772. Members of Congress want to hear about your personal experience and how it will impact you and your patients rather than receiving numerous pre-written letters. You can email your members of Congress directly, or you can edit the letter(s) linked here before submitting.
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