{
  "year": 2026,
  "diagnostic_radiopharmaceutical_packaging_threshold_usd_per_day": 655,
  "above_threshold": "strictly greater than $655 per day: separately payable under the applicable CMS methodology",
  "at_or_below_threshold": "$655 per day or less: packaged into the nuclear medicine test payment",
  "system": "Medicare hospital outpatient OPPS",
  "product_scope": "diagnostic radiopharmaceuticals without pass-through status",
  "threshold_metric": "CMS-estimated per-day cost for a product HCPCS code; not a dose invoice price",
  "payment_method_with_claims": "arithmetic mean unit cost (MUC) derived from hospital claims",
  "new_coded_nonpass_through_without_claims": {
    "ASP_available": "ASP plus 6 percent",
    "ASP_unavailable_initial_sales_period": "WAC plus 3 percent",
    "ASP_unavailable_after_initial_sales_period": "WAC plus 6 percent",
    "ASP_and_WAC_unavailable": "95 percent of most recent AWP"
  },
  "coverage_limit": "Payment classification does not establish coverage, a future FAPI-74 price, or eligibility for any particular patient.",
  "source": {
    "document": "CMS-1834-FC, 2025-20907",
    "publication_date": "2025-11-25",
    "effective_date": "2026-01-01",
    "section": "II.A.3.c(3)",
    "url": "https://www.govinfo.gov/content/pkg/FR-2025-11-25/html/2025-20907.htm"
  }
}