NOPR National Oncologic PET Registry. PET Reimbursement. Complex, slowly evolving process Dependent on FDA approval of PET drugs Facilitated by FDAMA (1997) Reimbursable clinical indications Determined by technology assessment panels of third-party payers
2002 Individual requests - several other cancers
Suspected Alzheimer’s disease vs. frontotemporal dementia
2004 Proposed mechanism for expanded coverage
Non-small cell lung cancer Lymphoma
Esophageal cancer Malignant melanoma
Colorectal cancer Head and neck cancer
NOPRNational Oncologic PET Registry
Who has access to NOPR data?
Participation Requirements - Patients
Referring Physician Responsibilities
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1. Check the single best match for the reason for the PET.
5. If PET were not available, your current management strategy would be (select one)?
Treatment Goal: (check one) Curative Palliative
Type(s): (check all that apply)
42 Primary and Metastatic Sites Listed
Includes Question for Referring Physician Consent
No Waiting Period
Providers Bill Medicare
Claim Form & Codes
UB/1450 Claim Form
1500 Claim Form
Modifier Use by Providers to Identify NOPR Claims
Use only with procedure, not necessary with the radiopharmaceutical billed on the same DOS as the procedure.
CMS Transmittal 956, 5/19/06.
V70.7 Use in the Second Diagnosis Position FL 68
From Current CMS policy CR 3741
A 72-year-old woman with diffuse large cell non-Hodgkin's lymphoma is undergoing chemotherapy with R-CHOP. PET/CT (skull-base to proximal thigh) is requested after the second cycle of treatment for monitoring of therapy.
A 67-year-old man has a history of glioblastoma multiforme of left parietal lobe treated with surgery, radiation therapy, and temazolamide. Follow-up MRI demonstrates a new 8 mm focus of contrast enhancement adjacent to the original tumor bed. Brain PET is requested for restaging, to distinguish recurrent tumor for radiation necrosis.
A 68-year-old woman has newly diagnosed dermatomyositis and progressive weight loss. CT of the chest, abdomen, and pelvis demonstrated no evidence of malignancy. Whole-body PET/CT is requested to detect an occult malignancy as the cause of her paraneoplastic syndrome.
Managed Medicare Plans – Medicare Advantage
NOPR Operations Office American College of Radiology 1818 Market Street, Suite 1600 Philadelphia, PA 19103 215-717-0859 800-227-5463 x 4859