SNMMI notes positive steps for radiopharmaceutical payments but says other changes may fall short of meeting clinical needs.
The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is raising concerns—and highlighting some wins—following the Centers for Medicare and Medicaid Services’ (CMS) release of the final CY 2026 Hospital Outpatient Prospective Payment System (OPPS) rule.
While the rule includes a new add-on payment for domestically produced Tc-99m, SNMMI warns that other reimbursement changes could strain hospital budgets and limit patient access to nuclear medicine procedures.
As part of the final rule, CMS raised the per-day cost threshold for diagnostic radiopharmaceuticals from $630 to $655. Although the agency declined requests to freeze the threshold for two years, it notes that it will monitor unintended pricing incentives.
CMS again declined to adopt an average sales price (ASP)-based payment for certain diagnostic radiopharmaceuticals, citing incomplete and inconsistent reporting. SNMMI expressed disappointment, noting that “the current payment method does not reliably reflect hospitals’ actual costs, while ASP data—updated quarterly—would provide a more current and appropriate measure.” The organization reports that it will continue to work with partners to engage CMS on this important reimbursement issue.
Other Highlights from the Final Rule
Add-On Payment for Tc-99m from Domestically Produced Mo-99: Beginning in CY 2026, CMS will use a $10 per-dose add-on payment for Tc-99m derived from domestically produced Mo-99. SNMMI supports this add-on payment and encourages CMS to give clear guidance on the documentation hospitals must maintain to verify that at least 50% of the Mo-99 used is sourced domestically. SNMMI also urges CMS to review the $10 add-on over time to ensure it remains appropriate and sufficient as domestic production and costs change. In addition, SNMMI urges CMS to expand the add-on policy to include Xe-133 and I-131, given their role in lung, brain, and thyroid imaging.
Procedure Payment Updates and New Codes: CMS reviewed several nuclear medicine procedures and finalized some payment adjustments based on updated hospital cost-report data. Several procedures will have payment reductions, reflecting last year’s policy change to pay separately for certain diagnostic radiopharmaceuticals. SNMMI expressed concern that these reductions could negatively impact hospital budgets, but CMS notes that its final rule must rely on the most current claims data.
“While the CY 2026 OPPS rule includes positive measures, it does not fully align reimbursement with the growing clinical importance of nuclear medicine,” reads a release from SNMMI. “As a result, hospitals may face financial pressures that could affect patient access to these increasingly vital diagnostic and therapeutic procedures. SNMMI will continue to engage with CMS to protect fair reimbursement for nuclear medicine procedures and to advance data-driven, specialty-appropriate policies.”
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