National Oncologic PET Registry
(NOPR)
The National Oncologic PET Registry - NOPR (www.cancerpetregistry.org) was developed in response to the Centers for Medicare and Medicaid Services (CMS) proposal to expand coverage for PET with F-18 fluorodeoxyglucose (FDG) for oncology indications not otherwise eligible for Medicare reimbursement. Medicare reimbursement for oncology indications covered under the NOPR can now be obtained by facilities that have registered with the NOPR to participate and fulfill NOPR program requirements for data submission.
Cardinal Health has developed a NOPR patient status tracking tool. The spreadsheets can be used to monitor the status of the patient in relation to the various NOPR required forms including when the patient was billed and payment received. There is an “Active” tab for patients currently in process, and then once payment has been received the information can be cut and pasted into the “Payment received” tab for a permanent record..
- NOPR patient status tracker (xls)
- NOPR patient status tracker (pdf)
- NOPR indications (pdf)
NOTE: Under the Hospital Outpatient Prospective Payment System (HOPPS), effective January 1, 2008, 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. For further details please click here.
Cardinal Health representatives understand local and national standards for reimbursement. They work with customers to develop the appropriate coding and language to maximize reimbursement. Cardinal Health’s PET Foundations™ program offers a particularly thorough reimbursement analysis program to PET customers. For example, because Alzheimer's Disease coverage is very specific, Cardinal Health has created a coverage criteria guide and a checklist/scan order form to help you educate and work with your referring physicians.
Cardinal Health also partners with others in providing up-to-date reimbursement information. For more information visit: The Society of Nuclear Medicine.
Note: The Society of Nuclear Medicine has published very useful spreadsheets (available in both .pdf and Excel formats) listing all the CPT/HCPCS codes used in Nuclear Medicine, their descriptions, APC assignment and payment rates under HOPPS 2008 compared to HOPPS 2007. Find these spreadsheets at: http://interactive.snm.org/index.cfm?PageID=1981&RPID=43
Spreadsheets applicable to the physician office/clinic setting may be found at: http://interactive.snm.org/index.cfm?PageID=1982&RPID=941
Also note: The March, 2004 Journal of Nuclear Medicine Technology offers a comprehensive article on FDG PET Reimbursement from Cardinal Health's own Jim Bietendorf: FDG PET Reimbursement. Bietendorf J. J Nucl Med Technol. 2004 Mar; 32(1):33-8 Free to Journal of Nuclear Medicine Technology Subscribers.
