Reimbursementjsc_3498sdf2025-01-31T21:51:39+00:00

Reimbursement

Reimbursement Support for Neuraceq^®

Neuraceq^® is a radioactive diagnostic agent indicated for Positron Emission Tomography (PET) imaging of the brain to estimate beta-amyloid neuritic plaque density in adult patients with cognitive impairment who are being evaluated for Alzheimer’s disease (AD) and other causes of cognitive decline. Neuraceq^® is an adjunct to other diagnostic evaluations. The most commonly reported adverse reactions were injection site reaction consisting of erythema, irritation, and pain.

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For questions related to coding, coverage, or payment using Neuraceq^® for Amyloid PET imaging, contact our Reimbursement team.

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Reimbursement Resources

Reimbursement Guide

Includes Neuraceq^® billing codes and details about access and reimbursement support services

Prior Authorization Checklist

If Prior Authorization is required, see guidance on what is needed to submit a request

IDTF/Non-Hospital Sample Claim Form

View a sample claim form for a physician office and Independent Diagnostic Testing Facility (IDTF)

Hospital Outpatient Sample Claim Form

View guidance for a sample claim form for a Hospital Outpatient facility

CMS Updates

CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1809-FC)

November 1, 2024

CMS finalizes separate payment for the hospital for diagnostic radiopharmaceuticals greater than a threshold of $630

Read more about this CMS news >

Centers for Medicare & Medicaid Services (CMS) retires the NCD, which eliminates CED and the 1 scan per lifetime patient limit

October 13, 2023

Centers for Medicare & Medicaid Services (CMS) retires the NCD, which eliminates CED and the 1 scan per lifetime patient limit

Read more about this CMS news >

Neuraceq® - Product Indications And Use

PRODUCT INDICATIONS AND USE: Neuraceq is indicated for Positron Emission Tomography (PET) imaging of the brain to estimate β-amyloid neuritic plaque density in adult patients with cognitive impairment who are being evaluated for Alzheimer's Disease (AD) and other causes of cognitive decline. A negative Neuraceq scan indicates sparse to no neuritic plaques and is inconsistent with a neuropathological diagnosis of AD at the time of image acquisition; a negative scan result reduces the likelihood that a patient's cognitive impairment is due to AD. A positive Neuraceq scan indicates moderate to frequent amyloid neuritic plaques; neuropathological examination has shown this amount of amyloid neuritic plaque is present in patients with AD, but may also be present in patients with other types of neurologic conditions as well as older people with normal cognition. Neuraceq is an adjunct to other diagnostic evaluations.

Limitations of Use:
A positive Neuraceq scan does not establish the diagnosis of AD or any other cognitive disorder. The safety and effectiveness of Neuraceq have not been established for Predicting the development of dementia or other neurologic conditions or monitoring responses to therapies.

IMPORTANT SAFETY INFORMATION:
CONTRAINDICATIONS: None

WARNINGS AND PRECAUTIONS:

Risk for Image Misinterpretation and other Errors
Errors may occur in the Neuraceq estimation of brain neuritic β-amyloid plaque density during image interpretation [see Clinical Studies (14)]. Image interpretation should be performed independently of the patient's clinical information. The use of clinical information in the interpretation of Neuraceq images has not been evaluated and may lead to errors. Errors may also occur in cases with severe brain atrophy that limits the ability to distinguish gray and white matter on the Neuraceq scan. Errors may also occur due to motion artifacts that result in image distortion. Neuraceq scan results are indicative of the presence of brain neuritic β-amyloid plaques only at the time of image acquisition and a negative scan result does not preclude the development of brain neuritic β-amyloid plaques in the future.
Radiation Risk
Neuraceq, similar to other radiopharmaceuticals, contributes to a patient's overall long-term cumulative radiation exposure. Long-term cumulative radiation exposure is associated with an increased risk of cancer. Ensure safe handling to protect patients and health care workers from unintentional radiation exposure [see Dosage and Administration.

ADVERSE REACTIONS:

The most commonly reported adverse reactions in clinical trials were injection site pain (3.4%), injection/application site erythema (1.7%), injection site irritation (1.1%).

DRUG INTERACTIONS:

Drug-drug interaction studies have not been performed in patients to establish the extent, if any, to which concomitant medications may alter Neuraceq image results.

USE IN SPECIFIC POPULATIONS:

Pregnancy : All radiopharmaceuticals, including Neuraceq, have a potential to cause fetal harm depending on the stage of fetal development and the magnitude of the radiopharmaceutical dose. If considering Neuraceq administration to a pregnant woman, inform the patient about the potential for adverse pregnancy outcomes based on the radiation dose from the drug and the gestational timing of exposure.
Lactation : There are no data on the presence of florbetaben F 18 injection in human milk, the effects on the breastfed infant, or the effects of florbetaben F 18 injection on milk production. Exposure of Neuraceq to a breastfed infant can be minimized by temporary discontinuation of breastfeeding. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for Neuraceq and any potential adverse effects on the breastfed child from Neuraceq or from the underlying maternal condition.
Pediatric Use: Neuraceq is not indicated for use in pediatric patients.
Geriatric Use: No overall differences in safety were observed between older and younger subjects

OVERDOSAGE:
A pharmacological overdose of Neuraceq is unlikely given the relatively low doses used for diagnostic purposes. In the event of administration of a radiation overdose with Neuraceq, the absorbed organ dose to the patient should be reduced by increasing elimination of the radionuclide from the body by inducing frequent micturition. Prior to Neuraceq administration, please read the full Prescribing Information for additional Important Safety Information.

SUSPECTED ADVERSE REACTIONS: please report to: https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program

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