Reimbursement and Technology Assessment for Positron Imaging.
The lack of consistent reimbursement for positron imaging has hampered the growth of this modality, thereby denying patients access to this important technology. Reimbursement has improved dramatically over the past three to five years with the most significant step occurring in January, 1998, which is when Medicare reimbursement was approved for staging lung cancer and characterizing indeterminate pulmonary nodules. The decision to reimburse for positron imaging for oncologic applications would not have occurred if clinical data were not available, and if the clinical effectiveness of positron imaging were not validated through technology assessments conducted by qualified research organizations. Even with the reality of reimbursement, the process by which positron imaging studies are reimbursed needs to be explored and standardized. On the Medicare front, each Medicare carrier will need help from the positron imaging community in implementing the Medicare National Coverage Instructions. The rate of reimbursement for positron imaging is a constant concern, especially with the variation of positron imaging devices and their associated capital and operational costs. This article summarizes the process involved in reimbursement for positron imaging, i.e., contracting with third-party payers and obtaining the support of referring physicians for positron imaging. The process of technology assessment for new procedures is integral to the growth, development and acceptance of positron imaging procedures by government and private-payer entities. We have made a significant step forward in reimbursement, but there is tremendous work to be done in establishing the process of reimbursement for positron imaging.