Payers evaluate SPECT/CT on case-by-case basis

August 1, 2006

Early adopters educate insurers about value of each component of fusion imaging

As the diagnostic CT side of hybrid imaging adds new clinical potential for nuclear practices, some sites are facing questions about how to bill properly for the procedures. While practitioners in Germany and the Netherlands have encountered no problems with reimbursement, the situation outside of Europe is different.

Payment problems are likely to arise with applications in which CT was not previously requested, said Dr. Paul Shreve, a radiologist with PET Medical Imaging Center and Advanced Radiology Services in Grand Rapids, Michigan. Imaging with SPECT/CT prior to vertebroplasty, for instance, should be fully reimbursable because patients would have received a CT examination anyway. This may not necessarily be the case with other potential applications.

One useful strategy is to talk with individual insurers prior to scanning, if time allows, and explain the value of each part of the SPECT/CT examination, said Dr. Stephen Scharf, chief of nuclear medicine at Lenox Hill Hospital in New York City.

"Medicare needs to do the same thing for SPECT/CT that it did for PET/CT; that is, recognize that there are times when fusion imaging makes sense and come up with separate codes for those applications. For the moment, we can only bill for CT if we are interpreting both portions of the examination as separate tests," he said. -PG