Nuclear medicine utilizes radioactive tracers (radiopharmaceuticals) to assess systemic functions as well as to diagnose and treat disease. Focusing on the former, SPECT scans are primarily used to diagnose and track the progression of heart disease, such as blocked coronary arteries. PET/CT scans have become the primary imaging tool for the staging of many cancers. Under the Outpatient Prospective Payment System (OPPS), CMS classifies all diagnostic radiopharmaceuticals as “supplies” instead of “drugs”. CMS instituted pass-through payments for new diagnostic radiopharmaceuticals to ensure providers receive adequate reimbursement while CMS collects the necessary data to potentially incorporate the cost into the OPPS rates. Parallel commercial payor behavior during and post-expiry of pass- through has ramifications on utilization, pricing and uptake; as does provider organization dynamics in response to reimbursement differentials. Herein, we introduce the fundamentals of nuclear medicine and present a decision- analysis structure in consideration of novel radiopharmaceutical tracers.