What’s New in PET/CT

CMS Final 2021 OPPS Rule, Physician Fee Schedule

PET/CT Reimbursement Updates for 2021
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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:
Final Changes to the Physician Fee Schedule for Calendar Year 2021 can be found at:


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

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