What is the NOPR? Minimize

NOPR Background

The National Oncologic PET Registry (NOPR) was developed in response to the Centers for Medicare and Medicaid Services (CMS) proposal to expand coverage for positron emission tomography with F-18 fluorodeoxyglucose (PET) to include cancers and indications not presently eligible for Medicare reimbursement. Medicare reimbursement for these cancers can now be obtained if the patient's referring physician and the provider submit data to a clinical registry to assess the impact of PET on cancer patient management. The NOPR is implementing this registry for CMS. 

The NOPR officially began accepting patient registrations on May 8, 2006. During nearly four years of operation, over 150,000 patients have undergone FDG-PET under NOPRs mechanism that allows for Medicare coverage of these scans. Based in part on these results, the NOPR investigators asked CMS in March 2008 to reconsider its coverage policy for PET. On April 3, 2009, CMS announced a new coverage policy for PET based in part on the results on the NOPR peer-reviewed, CMS expanded coverage for the use of PET for initial evaluation of patients with cancer to nearly all types of cancer and also allows for use of PET in subsequent treatment strategy evaluations for an expanded number of cancers. On June 11, 2013, CMS published a coverage decision to end CED for NOPR-covered FDG-PET indications, and to cover one FDG-PET scan for subsequent treatment strategy indications for all cancers. 

On February 26, 2010, CMS issued a decision memorandum regarding the use of PET with sodium fluoride F-18 (NaF-PET) for detection of bony metastasis. A new registry was developed during 2010 and is known as NOPR (NaF-PET). 

The NOPR is sponsored by the Academy of Molecular Imaging (AMI) and managed by the American College of Radiology (ACR) through the American College of Radiology Imaging Network (ACRIN)

The NOPR received input from, and is endorsed by, the ACR, the American Society for Clinical Oncology (ASCO), and the Society for Nuclear Medicine (SNM)

Patient Eligibility

Medicare beneficiaries who have Medicare as their primary insurance and who are referred for PET with sodium fluoride F-18 (NaF-PET) for detection of bony metastasis. 

PET Facility Responsibilities

Below is a brief summary of the data collection procedure.
  • When a patient eligible for entry into the NOPR presents at the PET facility, the facility contacts the referring physician and obtains confirmation that the referring physician will complete the pre- and post-PET data forms.
  • The PET facility registers the patient on the NOPR via a Web form, at which time a Registry case number is assigned.
  • The NOPR will send confirmation to the PET facility and e-mail a copy of the pre-PET data form to the PET facility administrator if it is indicated on the case registration form that the pre-PET form has not been completed by the referring physician
  • The referring physician must complete and return the pre-PET Form to the PET facility for entry into the NOPR database by midnight of the day of the PET scan.
  • After the PET scan is performed, the PET facility must submit the PET completion form within 14 days of the case registration date. completion form within 14 days of the case registration date.
  • After the interpreting physician reads the report, the PET facility sends the PET report to the referring physician, and submits the report text or a pdf or jpeg file. electronically to the NOPR database.
  • The data will send the PET facility administrator a Physician Scan Assessment. This form must be completed by the interpreting physician and entered into the NOPR database within 30 days of the PET scan.
  • The database will send the PET facility administrator a patient-specific Post-PET Form after the PET report Physician Scan Assessment has been submitted. This form must be completed, returned to the PET facility, and entered into the NOPR database within 30 days of the PET scan.

Referring Physician's Responsibilities

The patient's referring physician must agree to complete pre- and post-PET data collection forms consisting of a few questions regarding the patient's planned management.
  • The Pre-PET Form must be completed by the referring physician and returned to the PET facility prior to the patient's PET scan. If the form is not submitted with the referral a patient-specific form will be e-mailed to the PET facility administrator to be sent to the referring physician. The Pre-PET Form can be returned to the PET facility via, FAX, mail, or hand delivery.
  • After the PET is performed a patient-specific Post-PET Form 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. 

How to Obtain Medicare Reimbursement

The NOPR database will notify the PET facility when all case data have been entered. The PET facility can then bill CMS for the study. The PET facility can check on the case status of their patients at any time via the reporting tools available on the NOPR website. 

Sponsored by:
  • Academy of Molecular Imaging
Endorsed by:
  • American College of Radiology
  • American Society of Clinical Oncology
  • Society for Nuclear Medicine
Managed by:
  • American College of Radiology
  • American College of Radiology Imaging Network
Advisor:
  • Centers for Medicare & Medicaid Services
NOPR Working Group
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