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(3) Amount of Separate Payment for Diagnostic Radiopharmaceuticals Exceeding the Threshold As discussed in the CY 2025 OPPS/ASC final rule with comment period (89 FR 93955 through 93959), once we determine that the per day cost of a nonpass-through diagnostic radiopharmaceutical exceeds the cost threshold, proposed to be $655 per day for CY 2026, we will then assign that radiopharmaceutical to an APC, making it a specified covered outpatient drug (SCOD) per section 1833(t)(14)(B) of the Act

This positions it in stark contrast to competitors who often rely on consumer-facing marketing strategies, multi-compound blends, or exaggerated claims of bioavailability