2006 proposed fee schedule - American Society of Clinical Oncology

we would resolve any doubt on the matter in favor of our
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proposal because of the risk of abuse and anti-competitive
behavior inherent in physician self-referrals for nuclear
medicine services. The risk of abuse and anti-
competitiveness is exacerbated by the greater affordability
of nuclear medicine equipment, by our expansive coverage of
nuclear medicine services, and by the setting in which
mostly diagnostic and some therapeutic nuclear medicine
services now are primarily performed.
At the time we were preparing the Phase I final rule,
the vast majority of nuclear medicine procedures were
already subject to the physician self-referral prohibition
because they were primarily performed in hospital facilities
rather than in physician-owned freestanding facilities.
Thus, they were performed as inpatient or outpatient
hospital services and were therefore DHS subject to the
self-referral prohibition in accordance with section
1877(h)(6)(K) of the Act. Since publication of the Phase I
final rule, however, many more nuclear medicine procedures
have been performed in physician offices or in
physician-owned freestanding facilities. This has occurred
for several reasons. First, positron emission tomography
(PET) scanners may be used outside of a hospital setting.
Second, there have been significant technological advances;
an entity does not have to own a particle accelerator to