What’s New in PET/CT

CMS Final 2021 OPPS Rule, Physician Fee Schedule

PET/CT Reimbursement Updates for 2021
SOFIE Co., 21000 Atlantic Blvd., Suite 730 | Dulles, VA 20166
www.sofie.com January 2021 | CMS Final 2021 HOPPS ©
SOFIE Biosciences, Inc. 2021 / All Rights Reserved.

SMS WNIP Feb - 2021
SMS WNIP Feb - 20212

Final Changes to the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System, with Calendar Year 2021 Payment Rates can be found at:
https://www.cms.gov/newsroom/fact-sheets/cy-2021-medicare-hospital-outpatient-prospective-paymentsystem-and-ambulatory-surgical-center-0
Final Changes to the Physician Fee Schedule for Calendar Year 2021 can be found at:
https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicarephysician-fee-schedule-calendar-year-1

Chart

CMS Final 2021 OPPS Rule, Physician Fee Schedule

Hospital Outpatient Prospective Payment System (OPPS)

  • The payment rate for most PET and PET/CT scans will be increased 2.5% for this year:
    • PET APC 5594 in 2021 will be $1,480.34, compared with 2020 at $1,443.09

Medicare Physician Fee Schedule (MPFS)

  • CY 2021 PFS Rate setting and Conversion Factor:
    • Provided a 3.75% increase in MPFS payments for CY 2021
    • Suspended the 2% payment adjustment (sequestration) through March 31, 2021
    • Reinstated the 1.0 floor on the work Geographic Practice Cost Index through CY 2023
    • Delayed implementation of the inherent complexity add-on code for evaluation and management services (G2211) until CY 2024
    • The Appropriate Use Criteria (AUC) trial conducted in 2020 will continue in 2021

Connect with Us

Get additional information and stay up-to-date with the latest news by connecting with us on social media. 

Related News

AHRA 2022

RSNA 2021