Reimbursement Approaches for Radiopharmaceutical Dosimetry: Current Status and Future Opportunities

Area of Science:

• Nuclear Medicine
• Medical Physics
• Radiopharmaceutical Therapy

Background:

• Growing interest in dosimetry for clinical radiopharmaceutical therapy.
• Dosimetry is included in FDA-approved labels for several therapies.
• Patient-tailored treatment paradigms benefit from dosimetry.

Purpose of the Study:

• To present motivations and general workflows for radiopharmaceutical therapy dosimetry.
• To outline existing strategies for reimbursement of clinical dosimetry activities.
• To identify dosimetry services not currently supported by coding structures.

Main Methods:

• Review of current practices and literature by the Society of Nuclear Medicine and Molecular Imaging Dosimetry Task Force.
• Inclusion of specific patient examples with suggested reimbursement codes.
• Analysis of current reimbursement approaches and identification of gaps.

Main Results:

• Established motivations and workflows for dosimetry in radiopharmaceutical therapy.
• Provided examples of current reimbursement strategies and codes.
• Highlighted key dosimetry services lacking current coding support.

Conclusions:

• Clinical radiopharmaceutical therapy dosimetry is a growing field with established workflows.
• Current reimbursement strategies exist but have limitations.
• Future efforts should focus on developing coding and reimbursement for currently unsupported dosimetry services.