Information for Referring Physicians Minimize
NOPR Objective
The initial goal of the National Oncologic PET Registry (NOPR), which began operation in 2006, was to assess the effect of positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) on referring physicians’ plans of intended patient management for those cancers and indications that were not eligible at that time for reimbursement under the Medicare program, based on the national PET coverage policy of the Centers for Medicare and Medicaid Services (CMS). After the April 2009 expansion in CMS coverage for FDG-PET, the NOPR continued to collect similar data for many remaining cancer indications for FDG-PET (NOPR 2009). This data collection ended in June 2013, when CMS again revised its coverage policy for FDG-PET to allow for coverage of all cancer types and indications. 

Additionally, beginning in 2011, based on a February 2010 National Coverage Decision, the NOPR began collecting data on referring physicians’ plans of intended patient management for Medicare patients undergoing PET with sodium fluoride-18 (NaF-PET) for evaluation of proven or strongly suspected bony metastatic disease (NOPR (NaF-PET). 

Data are collected from the referring physician before and after the PET study, and from the interpreting physician. If complete and timely data are reported to the NOPR within 30 days of the PET scan, the PET facility and interpreting physician (nuclear physician/radiologist) will be eligible for reimbursement by CMS. 

Collection of the information required by the NOPR is a condition for reimbursement of the PET scan by the Medicare program for eligible patients. CMS has designated this mechanism for reimbursement as “coverage with evidence development.” (CED) Such patients would otherwise be required to pay for the PET study themselves, or would not have PET performed at all. 

PET Facility Participants
Any PET facility that is approved to bill CMS for either technical or global charges can apply to participate in the NOPR. PET facilities are charged a one-time $50 facility registration fee and $50 for each patient entered on the Registry. There is no charge to referring physicians or to patients for registry participation. There is no payment to referring physicians for completion of the required Pre-PET and Post-PET forms. 

Patient Eligibility
Medicare beneficiaries who are referred for NaF-PET for evaluation of bony metastatic disease are eligible to participate in the NOPR. 

Referring Physician's Responsibilities
The patient's referring physician must agree to complete Pre- and Post-PET data collection forms that include questions regarding the patient’s planned management.
  • The Pre-PET Form must be completed and signed by the referring physician and returned to the PET facility prior to the patient’s PET scan. Blank Pre-PET Forms for NaF-PET can be downloaded from the NOPR Web site and sent to the PET facility at the time of patient referral. If the form is not submitted with the referral, a patient-specific form can be obtained from the PET facility. The Pre-PET Form can be returned to the PET facility via FAX, mail, or hand delivery.

  • After the PET scan is performed, a patient-specific Post-PET Form for NaF-PET will be sent to the referring physician for completion within 30 days. This form can also be returned to the PET facility via FAX, mail, or hand delivery.
The case is eligible for CMS reimbursement only if the Pre-PET Form is completed and returned to the PET facility prior to the PET scan and the Post-PET Form is completed and returned within 30 days of the PET scan. 

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