SNMMI confirms HOPPS payment rate error for CERIANNA (Fluoroestradiol F-18) injection

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SNMMI confirms HOPPS payment rate error for CERIANNA (Fluoroestradiol F-18) injection

Press releases may be edited for formatting or style | February 09, 2021 Molecular Imaging
SNMMI has been working with Zionexa to seek proper Medicare reimbursement for Cerianna, radiolabeled 18F-fluoroestradiol indicated for use with positron emission tomography (PET) imaging for detection of estrogen receptor–positive lesions as an adjunct to biopsy in patients with recurrent or metastatic breast cancer. As of January 2021, the HOPPS published rate for this product is incorrect. SNMMI and Zionexa are working closely with the Centers of Medicare and Medicaid Services (CMS) to confirm their agreement with our interpretation and to obtain an implementation date. It is our understanding and interpretation of the Redbook AWP and WAC that the correct rate should be $608.33 per millicurie instead of $0.752 per millicurie.

If you are encountering issues with your MAC, please notify SNMMI at hpra@snmmi.org. CMS has told us that any corrections would be retroactive to January 1, 2021. SNMMI will notify our members and update the Q&As when any corrections are implemented. Unfortunately, we are likely to see corrections at quarterly intervals, so the next is likely to be published in March for April 2021 or July 2021 implementation.

As a reminder, for claims with a date of service January 1, 2021, and beyond (for all payers in all settings), please use A9591 Fluoroestradiol F-18, diagnostic, 1 millicurie.

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