HOPPS Proposed Rule Increases Reimbursement for Some PET/CT Services

CPT codes 78432 and 78433 would be reassigned to different ambulatory payment classifications (APCs) to reflect the increased costs associated with providing the services whereas CPT code 78431 would not move.

Moving Up: CPT 78432 and 78433 Reclassified in Higher-Value APCs

• CPT 78432 – Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (e.g., myocardial viability). CMS is proposing to reassign this code to APC 1521 from APC 1520. This change is because the new arithmetic mean cost for this service is now above the cost band for APC 1520.
• CPT 78433 – Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (e.g., myocardial viability) with concurrently acquired computed tomography transmission scan. CMS is proposing to move this code to APC 1522 from APC 1521 due to an increase in the geometric mean cost.

High-Volume CPT 78431 Remains Stable

CPT 78431 – Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan. Under the HOPPS proposed rule, reimbursement for this PET/CT code, which has the highest volume, would remain in the current APC, thus resulting in stable payment for 2025.

Coming Soon: Further Analysis, Calls to Action, and Member-Only Payment Charts

ASNC is continuing to analyze both proposed rules. Stay tuned for updates on CMS’s proposals that will impact your practice and possible calls to action. In addition, ASNC’s reimbursement analysts are developing charts compiling the proposed rates for nuclear cardiology services in 2025.

These charts are a valuable benefit of ASNC membership. They will provide an at-a-glance summary of the payment codes that matter most to your practice, helping you make informed budgeting and other practice management decisions.

Want access to these helpful charts plus many more benefits of ASNC membership? 

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