New law adjusts payment rate for radiopharmaceuticals

August 11, 2008

Reimbursement for radiopharmaceuticals will be maintained at the 2007 rate through Jan. 1, 2010, thanks to the Medicare Improvements for Patients and Providers Act of 2008.

Thanks to the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), the reimbursement for radiopharmaceuticals, such as Zevalin (ibritumomab tiuxetan, Cell Therapeutics Inc.), will be continued at the 2007 rate for 18 months through Jan. 1, 2010. This is a relief to providers, since CMS had put in place as of July 1 an outpatient prospective payment system (OPPS) rate that is lower than the acquisition cost for these products. CMS said that contractors will mass adjust all already-processed OPPS claims with dates of service beginning July 1 as soon as the new MIPPA payment methodology has been implemented. Reprocessing will be complete by Sept. 30.