CMS Eases Path to Oncology PET Tracer Coverage

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The Centers for Medicare and Medicaid Services (CMS) has issued a decision memo that would allow local Medicare Administrative Contractors (MACs) to determine coverage for PET imaging using radiopharmaceuticals that are newly approved by the U.S. Food and Drug Administration (FDA) and do not yet have a national Medicare coverage determination.

Specifically, according to the decision memo, "new PET radiopharmaceuticals would be subject to local contractor determinations under section 1862(a)(1)(A), rather than be automatically non-covered under the terms of section 220.6."

The lack of coverage for PET imaging using newer tracers had slowed the process of getting these new radiopharmaceuticals into practice where they could help patients.

“MITA has long supported Medicare coverage decisions that facilitate access to PET imaging, which has revolutionized the diagnosis, treatment and monitoring of a wide range of diseases," said MITA executive director Gail Rodriguez in a statement acknowledging the CMS decision. "By removing the national non-coverage decision for PET imaging in oncology and allowing local Medicare carriers to determine coverage, physicians and patients will benefit from these cutting-edge tools to detect cancer and evaluate treatment. We are encouraged that CMS has taken an important first step in covering PET procedures, but disappointed that broader PET coverage decisions for cardiac and neurological applications were not included in this final decision."