The “FIND” Act, or Facilitating Innovative Nuclear Diagnostics Act, aims to improve access to advanced radiodiagnostic imaging for early diagnosis of heart disease, neurological disorders, and cancer to enhance patient outcomes.
In May 2024, the U.S. House of Representatives passed the FIND Act. It requires separate payment for radiopharmaceuticals costing over $500 per day for outpatient procedures under the Hospital Outpatient Prospective Payment System. Radiopharmaceuticals like Tc-99m and Rb-82, which cost less than $500 per day, remain bundled in procedure payments. The Act ensures that separate payment does not affect copayments for Medicare beneficiaries.
As of May 2025, the FIND Act has not been enacted into law.
Is FIND Act still relevant?: The revised Medicare reimbursement policy for advanced radiodiagnostics was effective January 1st, 2025. It separates the payment package and provides individual reimbursement for diagnostic radiopharmaceuticals with a per-day cost exceeding $630. This policy maintains stable reimbursement for high-cost radioimaging agent procedures after the traditional expiration of pass-through status.
The FIND Act proposes a lower threshold of $500 compared to the $630 threshold established by CMS. As a result, more diagnostic radiopharmaceuticals may qualify for separate reimbursement under the FIND Act, potentially enhancing access to a broader range of innovative imaging agents. As of May 2025, the FIND Act has not been enacted into law.
Radioimaging agents with transitional Pass-through status : In this category, for outpatient imaging procedures, CMS reimburses 100% of the cost for the imaging agent. The patient cost seems to be different for a procedure performed in hospital vs. ASC setting: one reference (CRSToday | J-Codes and Pass-Through Status) states that “For products with pass-through status that are used in a hospital setting, the CMS reimburses 100% of the cost for patients covered by Medicare Part B, and no copayment applies. When a drug or device with pass-through status is used in an ambulatory surgery center (ASC), however, the statutory 20% copayment applies, although it is typically covered by a patient’s supplemental insurance.”
How does costs for pass-through candidates compare to revised reimbursement policy: For patients, a “pass-through” status in imaging procedures typically leads to lower out-of-pocket costs compared to the revised reimbursement policy. Pass-through status often means Medicare (and subsequently other insurers) will pay for the full cost (or a high percentage) of the item, with no copayment or deductible for the patient. Revised reimbursements, on the other hand, may include copayments or deductibles, potentially making pass-through candidates more economical.