• MEDICARE / CMS and Reimbursement for Advanced Radiopharmaceuticals

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    On October 18, 2019, an opinion piece that NorCal CarciNET Community’s Josh Mailman opinion article (“CMS policy shouldn't penalize those with rare disease”) was published by The Hill,  The opinion piece highlighted the challenges with the current method that Medicare/CMS use to pay for radiopharmaceuticals. This webpage provides more information on how this will impact NET patients and providers along with a  tool for those that are interested in taking action.

    The Medicare Diagnostic Radiopharmaceutical Payment Equity Act of 2019 (H.R. 3772),  which many in the nuclear medicine community are working on to help improve, will impact Medicare payments for imaging only. This bill is not looking at broader medical payment, billing or cost issues.


    In 2008, Medicare/CMS simplified how CMS paid for PET Imaging. The simplification reduced an infinite combination of supplies and tracers to a few PET bundles based on tracer cost. These bundles allowed a provider to bill for all PET imaging in a simplified manner. The most expensive bundle is ~ $1,400 (there are some regional adjustments).

  • Medicare 2018


    Please note that Medicare 2018 open enrollment is October 15, 2017 - December 7, 2017.


    On November 16, NorCal CarciNET Community hosted a webinar to help NET Patients around the country better understand the process for selecting PART D Medicare Coverage. 

    We were pleased to have Ann Kayrish from the National Council on Aging (NCOA) as our guest. Ann recently joined NCOA as a Senior Program Manager, for Medicare. Click here for the slide deck used in the video

    Educational support for our webinar was provided by Lexicon


    By now you may have received your copy of “Medicare &You 2018” from the Centers of Medicare and Medicaid Services. This is a manual containing information regarding Medicare coverage choices, things to consider when choosing Medicare, and important enrollment information. At the very end of the manual, you will find information specific to Medicare plans in your geography.

    “Medicare&You 2018” Handbook

    (This is a general version and will not have plans specific to your area)

    Another resource is the online Medicare tool,
    Below are general descriptions only of the search tool.

    If you are looking for more information or to compare Medicare Plans, please go to You are able to do a General Search or a Personalized Search.

    If you perform a Personalized Search, you will need to have your Medicare number, your birthdate, and input the zip code that Medicare has on record for you. If you also are comparing Part D plans, have a list of your drugs, exact name, dose, and quantity.


    At the bottom of either the General Search or the Personalized Search, click Find Plans. Answer the following questions as appropriate and click on Continue to Plan Results. From here, you will need to enter your drugs exactly. After your drug list is complete, you will need to select a pharmacy. Once you choose a pharmacy, you will click on Continue to Plan Results.

    From here, you can refine your plan results such as click on Prescription Drug Plans (with Original Medicare) or click on Medicare Plans with drug coverage. Now click on Continue to Plan Results. You will be able to see a list of available options and be able to sort results. If you are doing a Personalized Search, your plan will appear above the results.

    Thanks to Lexicon for helping to pull together this information as excerpted from Medicare .gov and Medicare & You 2018